The latest guidelines

Until a few years ago, it seemed that if women didn’t get tested regularly for breast and cervical cancer, they would almost certainly end up with the disease.

Then, recently, different recommended ages for initial mammograms, longer waits between Pap smears, and even recommendations not to do self-breast exams came out. In addition to the confusing new timelines, the guidelines easing the regularity of tests have made some women feel uncomfortable because they don’t understand the reasoning behind limiting the tests they believed were crucial to their health.

The recommendation making many patients nervous is the scaling back of the Pap smear, which tests for cervical cancer. The American College of Obstetricians and Gynecologists has been supportive of decreasing the use of the Pap smears through the years. This year, the U.S. Preventive Services Task Force, the American Cancer Society, the American Society for Colposcopy and Cervical Pathology and the American Society for Clinical Pathology all supported limiting the Pap smear to every five years for women over 30. The reason why they’ve scaled it back is because if you do not have the human papillomavirus, you cannot get cervical cancer.

There are risks to over-screening which, combined with over-treatment, can lead to complications including pre-term birth in the future. Those risks need to be balanced with the risks of cervical cancer.

Also, patients are nervous about the new guidelines for the mammogram, clinical breast exam and self-breast exam. It is important to realize that mammograms cannot catch everything, but when a patient is knowledgeable about her breasts, her doctor has a regular record of her breast health, and mammograms are used appropriately, that can help catch some breast cancer at an earlier stage. A regular clinical breast exam can help guide women in how they feel their breasts and what feels normal versus what may feel different

Here are the latest guidelines for the tests based on age.

Regardless of age – See a doctor every year. This is possibly the most important thing you can do to make sure you stay on a good path. Your doctor can check your vital signs, lymph nodes, perform clinical breast exams and pelvic exams and recognize risk factors for your health.

For patients under 21 – Teenage girls should have their first visit to an OB-GYN between the age of 13-15. There is no pelvic exam, just patient education, discussion of body changes, making sure immunizations are up to date, and talk about sexually transmitted infections and contraception. Even if the girl is sexually active, if there are no symptoms, she does not need an internal exam. She can be tested for sexually transmitted infections without using a speculum.

For patients 21 to 30 – Women should get a regular internal pelvic exam and STI screening every year and Pap smears every two years. The American College of Obstetricians and Gynecologists will likely recommend Pap smears every three years soon. Women should also get clinical breast exams every 1-3 years.

For patients 30 and over – The current recommendation is that women aged 30 and over who have had no medical issues receive Pap smears every three years. The American College of Obstetricians and Gynecologists will likely move this to every five years soon. Women should still get regular internal pelvic exams and clinical breast exams every year.

For patients 40 and over – Women should get mammograms and clinical breast exams every year. They should also get pelvic exams annually. Again, Pap smears are currently recommended every three years, but will likely be moved to every five years until 65-70, depending on the woman’s medical history.

Of course, if you notice anything different about your body, let your doctor know. If you have established a regular visit and a “normal” standard for your body, it will become even easier to notice when something is not quite right.

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