A pap screen annually makes as much sense as an colonoscopy every year. I hope the gastroenterologists don't figure out they can offer their own "wellness" exam (say, sigmoidoscopy plus two equally silly palpation screens as the pelvic exam and clinical breast exam), or we're all in trouble.
Cervical cancer actually has a lot in common with colon cancer. Both are very slow growing, hard to detect and the screens are invasive, disgusting, humiliating and prone to errors. One field decided to recommend a screen every 10 years and the other every year. Who is right?
A Pap screen has a false positive risk of roughly five percent and a false negative rate of roughly 10 percent. Since OBGyns like false positives (more work) and don't consider either a false positive or the invasiveness of pap to be an issue, they came out with an impossible-to-defend recommendation of an annual pap. This did almost nothing to reduce an already tiny false negative risk from a three-year Pap, but created a massive false positive problem (lifetime risk is 80 percent or so with 50 annual paps). Some 22 years after the American Cancer Society said stop, the ACOG finally acknowledged what every high schooler with a stats class under the belt knew: you weren't helping women, you were hurting them. So then we get the three-year Pap. It's a step in the right direction, but three to five years is the sweet spot between the error rates for Pap and it is five years for women in their 50s through the end of screening because the HPV-to-cervical-cancer cycle lengthens.
But the bigger issue is that while getting a Pap only every three years is obviously better than a Pap every year, a fact that was obvious from the data for decades, it sucks eggs relative to HPV-DNA / Pap which is recommended every five years. Yes, there is a more accurate test that lengthens the testing interval. And honestly, while the guidelines say five years, the data actually shows neg-HPV / neg-Pap is good for at least six years.
Want better news? HPV DNA can be done on self-collected samples (and is in many other countries). Eventually the FDA will stop playing doctors trying to protect doctors and HPV DNA and sDNA will be released to the home testing market. Both will be significantly more sensitive and specific than the barbaric invasive biopsies they will replace, mainly the pap and the colonoscopy. Perhaps then the specialists administering the tests can stop pretending to the "meat" our there that these are not traumatic, etc.
By the way, one of the more disturbing elements of the Pap industry (and for the record, the Pap is the best of all the pathetic screens the ob-gyn well woman industry has) is that we have likely been screening neg-HPV, neg-Pap women living lifestyles that preclude HPV infection each and every year, using a foreign object to gain access and there's been no purpose. I refer to the dormancy theory, which the industry uses to keep these women coming back year after year. The idea is that HPV is lurking, undetectable by either Pap or HPV DNA until a time when your immune system isn't looking and then bam! The latest research suggests dormancy is rare. Further, dormancy/chronic infections of other viruses (Hep B) tends to afflict the young (vs. mature) and we know from the data this appears to be the case with HPV (i.e. more dangerous if infected while young). If the dormancy theory is discredited, then the speculum and cervical brush are going to be collecting a lot of dust.
I am still amazed how little women understand of the "wellness" industry, the limits of screening technology, where their threats lie and how their threats compare to males.
1. There is no screen for ovarian cancer. A pelvic exam is not one. There is no agreement on how one is to interpret a pelvic exam and it appears valueless in the asymptomatic (actually it's a rich source of false positives). ACOG essentially admits all this in its 2012 update, but mind-bogglingly recommends an annual pelvic exam anyway (again, it's "costless" to women and false positives are not a bad thing for them). The dirty little secret is that a pelvic exam reimburses at the highest rate compared to other procedure codes and they can do them in two to three minutes without anyone calling the quality into question. It's money (some power dynamics too).
2. We are screening young women for a mature woman's diseases. Average age at diagnosis for cervical cancers is 48, but 61 for breast cancer and 63 for ovarian.
3. A Pap screen has a false positive rate of five to 10 percent and false negative rate of 15-20 percent. Some 30 percent of new cervical cancer patients had a negative pap within the last three years. But if you overuse a crappy diagnostic, you send healthy women for colonoscopies and worse. Women need to be informed of the trade-offs so they can decide the testing interval for themselves.
4. A clinical breast exam (again, palpation is a crappy screening technology) is worthless in a mammogram population. It is also a rich source of false positives.
5. Reproductive system cancers for males are every bit as common as for women (add up testicular, prostate and compare with breast, ovarian, cervical, etc.). But males are not subjected to inspection programs that don't work nor coerced and pressured into compliance (despicably by withholding access to birth control).
6. The no. 1 killer of women is CV disease. And its rise is because of a "wellness" program that is fixated on female sexual organs. I don't care if your OB-GYN takes your blood pressure. The focus is pap, pelvic and breast exam. Either redirect the spending power elsewhere or get a new specialist (a cardiologist perhaps).
So here's the bottom line: Get a HPV-DNA /Pap every five or six years. Look for home testing options (bang on the FDA). Get your scrape from a nurse practitioner so you avoid the pressure to have a "costless" pelvic and breast exam because you're already there and you might as well and it's just part of being a woman (etc, etc). Get serious about having your lipid profiles, bp monitored, etc. None of this requires a wellness exam, much less one that is annual.