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- Millions of Unnecessary Pap Tests? Overuse of Cervical Cancer Screenings
- Huntsman Cancer Foundation
- Facts and Figures
- Top Science 2013 Summary
A Pap test—in which a sample of cervical cells is taken to check for changes that could lead to cancer—has long been a standard part of routine health care for women in the United States. But some women may not need this test. In fact, it turns out that over the past ten years, upwards of 14 million women received an unnecessary Pap test.
A recent study co-authored by Huntsman Cancer Institute investigator Deanna Kepka, PhD, assistant professor in the College of Nursing at the University of Utah, looked at data from the 2010 National Health Interview Survey for cervical cancer screening among older U.S. women and found unnecessary use in two groups: those over age 65 with no history of abnormal Pap tests and those who had had a hysterectomy.
Since 2003, the U.S. Preventive Services Task Force (USPSTF) has recommended that Pap tests are unnecessary for these two groups of women. The USPSTF is an independent panel of experts in prevention and evidence-based medicine comprised of primary care providers.
“Almost two-thirds (64.5%) of women who have had hysterectomies reported having recent Pap tests,” said Kepka. “And half (50.4%) of women over 65 who have no cervical cancer history also reported a recent Pap test.”
Because the risk of developing this slow-growing cancer is very small at a late stage in life, Pap tests do not benefit women over age 65 who have no history of cervical cancer or precancerous conditions. In addition, women who have had hysterectomies do not benefit from the test because nearly all of them no longer have a cervix.
“We knew there would be overuse of Pap tests because studies of cervical cancer screening showed overuse ten years ago,” said Kepka. “But we were shocked to see so little change over the past ten years.”
See the current Pap test guidelines from the Centers for Disease Control and Prevention.
“Women should know their health history and talk with their health care providers about the Pap test,” says Kepka. “We know the test is no longer needed on an annual basis. Current guidelines suggest women get one every three years, or as recommended by their health care providers.”
As Kepka discovered, the challenge is getting women and their providers aware of the current Pap test guidelines. “Ten years ago, the USPSTF recommended the change in Pap test guidelines. Then in 2012, the American Cancer Society and the American College of Obstetricians and Gynecologists released similar guidelines. During that same year the USPSTF released new guidelines related to the use of HPV co-testing and expanding Pap testing intervals. It is possible to make women and their providers aware of this so we avoid overuse of the Pap test and focus on cancer prevention efforts that may be more useful.”
Kepka’s research will continue in this area, looking at the demographics of women likely to receive unnecessary Pap tests, and to examine how this information applies to Utah women.
“We’re hoping to see better use of the tests over the next decade as changes in the health care infrastructure take place,” she added. “Electronic medical records, health care provider reminder systems, decision support, and new strategies to improve the quality of care may promote guideline-consistent practices among clinicians.”
The research results were published online in the Journal of the American Medical Association Internal Medicine in November 2013.