Pap smears guidelines

[tooty]

http://www.cmaj.ca/content/185/1/35.full.pdf

 

Heads up. Earliest recommended age to start pap smears is now 25, repeat every three years when normal until age 70. Stop at age 70 only if last three were normal.

 

Do we go with the Task Force for exam/osce purposes?

[Laika]

It's a controversial area, and not everyone agrees with the new guidelines.

 

http://sogc.org/media/documents/medCervicalCancerScreeningENG130220.pdf

 

I doubt it would come up on an exam because things are in flux right now. On an OSCE you can say some groups recommend 25, others 21, etc...

[NLengr]

For a written exam I agree it's unlikely to come up; too controversial.

 

For an OSCE, pick one Canadian groups guidelines and know them. Acknowledge alternatives exist.

 

It's similar to how you won't be asked detailed questions about PSA screening guidelines. You just need to know there is controversy and they exist.

[kylamonkey]

What about if pt has had HPV? Still every 3 yrs?

[tooty]

Since HPV is so common, we assuming everyone is infected when we encourage every woman to undergo screening. The pap smear is already pretty awesome. There is currently little evidence to suggest a mortality benefit with the implementation of HPV testing on top of the pap. Sankranrayann from India found some benefit in women who were never screened before. Anttila from Finland found no benefit. But since HPV vaccines are becoming more common, HPV testing will probably play a significant role for the next generation.

 

So yes, still every 3 years because chances are they're infected.

 

Sankaranarayanan R, Nene BM, Shastri SS, et al. HPV screening for cervical cancer in rural India. N Engl J Med2009; 360:1385- 94.

Anttila A, Nieminen P. Cervical cancer screening programme in Finland with an example on implementing alternative screening methods. Coll Antropol2007;31:17-22