Cervical screening: Expert calls on Australia to change policy
Australia should reduce the frequency of Pap smears and increase the age at which women start having Pap smears, according to Professor James Dickinson in an article published in the latest issue of the Medical Journal of Australia.
Professor Dickinson, who is Professor of Family Medicine at The Chinese University of Hong Kong, has instead called for more resources to be allocated to enrolling women who are currently underscreened and to evaluating and improving Australia's national cervical screening program.
Professor Dickinson said the currently recommended two-year interval between Pap smears (for women aged between 18 and 70 years) should be changed to a scientifically supported three-year interval.
He said that at the time the "organised approach" to cervical screening was implemented in Australia in 1991, the intention was to review the two-year interval once safeguards had been proven effective.
"Most countries with national policies recommend a three-year interval between Pap smears. The United States and Germany are exceptions in which certain government or professional bodies recommend annual smears", Professor Dickinson said.
"Finland is notable for its five-year interval, which, since its introduction in 1963, has led to a 90% reduction in squamous cervical cancer incidence. Finland's experience shows that, for an effective program, ensuring full population coverage is more important than frequent smears," he said.
In calling for an increase in the recommended age at which screening starts, Professor Dickinson said there was evidence that starting too early may cause considerable morbidity as a result of the procedures used to investigate false positive results. For young women the chance of benefit is small, leaving on balance a greater risk of harm.
"As the frequency of smears increases, the benefits (in terms of detection and prevention of cancers) increase only marginally, while costs and potential harm rise substantially. Therefore, reducing the amount of unnecessary treatment by reducing the frequency of smears and starting them at a later age is worthwhile, provided this does not substantially increase the chance of untreatable invasive cancer.
"Greater value per dollar and less chance of harm would be obtained by redirecting energy and funding to currently under-served and high risk groups of women," Professor Dickinson said.
The Medical Journal of Australia is a publication of the Australian Medical Association.
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