New Canadian Task Force guideline: Start Pap tests at age 25, not 18

The Canadian Task Force on Preventive Health Care has issued new recommendations for cervical cancer screening.

They recommend starting routine Pap tests at age 25, a significant change to the previous (1994) guideline that Paps tests start at age 18 at the latest.

The main changes in the new guidelines are:

-  Routine Pap tests are not recommended for sexually active women under age 25. Previously, Pap tests were recommended when a woman first started being sexually active, or at age 18, whichever came first.

- For asymptomatic women (women without symptoms of cervical cancer) from age 25-69 who are or have been sexually active, Pap tests are recommended only every three years. Previously, the recommendation varied, but generally annual tests were recommended for women 20-69, possibly changing to once every two or three years after two normal tests in a row.

-  Screening is now more explicitly recommended in women over 69 if “prior screening has not been adequately performed.” Previously, screening for women 70 and older was not recommended.

The reasons given for these change are:

-  The Task Force recommends against cervical cancer screening (with Pap tests) for women aged younger than 25 because minimal or no benefit was found to outweigh the potential harms in this group.

- The Task Force found moderate quality evidence showing that screening with Pap tests may have a small effect in reducing cervical cancer mortality and morbidity among women aged 25‐29 and recommends screening these women at intervals of 3 years.

- The Task Force found high quality evidence showing that screening for cervical cancer with Pap tests reduces mortality and morbidity among women aged 30‐69, and strongly recommends screening these women at intervals of 3 years.

- Screening may cease in women aged 70 and older, but only after 3 successive negative Pap tests.

Read the Task Force's press release [3].

Read the new Guideline on cervical cancer screening [4].

Read Pap tests should start later, new guidelines recommend [5] (Globe and Mail).