I'm glad that you were so lucky. But every time someone gets a Pap, there is a chance it will find abnormal cells that would have remained harmless or vanished over time rather than turning into cancer. Such harmless "abnormalities" are fairly common in younger women. Surgically removing them rarely has serious immediate complications, but it weakens the cervix and can impair a woman's ability to carry a pregnancy to term. The more often you screen, the more women would be subjected to surgery for temporary and harmless abnormalities. There's nothing magic about annual screening. Should we screen everyone every six months, since that was what apparently saved you? Every three months? (Assume that all women are rich and can take time off work at will, so money is no object.) Every shortening of the screening interval would indeed save an extra handful of lives. But it would also hugely increase the number of unnecessary procedures, and that would mean more miscarriages down the road. For many women, the ability to bear children is an important part of a happy life. How many miscarriages have to be caused for every life saved before the average healthy woman would say she didn't like the odds?

dsb wrote " Sorry, Paps and the annual checkups aren't that hard. Seems a small price to pay "

Women shouldn't be limited in their use of health services. Just split the men's and women's plans, add all the health services that women want and pay accordingly. Women will certainly pay more and can opt for 3, 6 9, 12 month check-ups for whatever they want. There should also be a way to pay out-of-pocket.

Sorry to hear about your health scare. I am 27 and had a pap come back abnormal last year then a biopsy was performed and there was nothing wrong. A year later another abnormal pap and they want another biopsy. If it happens to come back fine again I am switching to the 3-5 year rule. Biopsy's aren't exactly somethin I look forward to.

SLN73,I was diagnosed and treated for cervical cancer at age 24.My mother was prescribed DES to prevent miscarriage.this drug was routinely used in the late 40's into the early 60's.this type of cervical cancer is a clear cell cancer.This article states that the HPV virus is the only cause of cervical cancer is untrue.The CDC and most doctors know about DES and yet they have ignored the repercussions of that drug.

The HPV vaccine protects against four strains of HPV, the four most common to lead to cancer, and cite your source that the vaccine is "related" to the deaths of 500 women.

Gardisil works against the strains of HPV that cause 80% of cervical cancers. over your lifetime. if there was a vaccine that protected you or your child against 80% of lung cancer, or colon cancer, or skin cancer you and most people would be lined up around the block to get it. my 18 year old nephew has recently elected to receive the HPV vaccine so that he can never accidently give genital warts to a woman he cares about. I wish some other 'adults' would be as mature

Wish they came out with gardisil sooner. My gyno said about 80% of sexually active people have HPV.

Gardisil works against the strains of HPV that cause 80% of cervical cancers. over your lifetime.

Except no one knows that. Gardasil hasn't been around long enough (since 2006) to say HOW long it gives protection.

Wish they came out with gardisil sooner. My gyno said about 80% of sexually active people have HPV.

This is true (HPV of some sort, anyway) and has been for years and years and decades. Centuries, even. However, that 80% infection rate does not translate into 80% of sexually active people getting cancer. The great majority of HPV sufferers will never even know they have it, and shed the infection with no later problems.

Excuse me. I meant to say that cervical cancers, and their origins, have been studied for a long time.

• The disease has been known since ancient times. In 400 BCE, the Greek physician Hippocrates wrote about the disease and even attempted to treat the cancer with a procedure known as the trachelectomy, although he found that nothing he did could eradicate the cancer. This procedure, later used for a brief period in the 1940s, involves removing the cervix and linking the vaginal canal directly to the uterus.

• For centuries, doctors were confused as to the cause of cervical cancer. The first theory rose to prominence in 1842 in Florence, when a doctor noticed that married women and prostitutes were susceptible to cervical cancer, but nuns had a very low incidence of the cancer. However, because nuns did suffer from breast cancer, it was incorrectly determined that the cause of both diseases was tight corsets.

  Read more: The History of Cervical Cancer | eHow.com http://www.ehow.com/about_5554342_history-cervical-cancer.html#ixzz2A9lF7DGd

I really don't know what the rates of HPV infection have been, through the years.

Allie22,Protected sex prevents all of the STD's if used every time and properly.

I'm about ready to invent a smart-virus that only targets people who tout conspiracy theories like these.

Pap tests are actually not that expensive. They take a little swab and send it off to a tech, who spends 5 minutes looking at it under a microscope. They cost, on average, around $200. The quarterly blood tests I have for my thyroid condition, in comparison, cost $1000.

And believe it or not, docs don't really much enjoy doing pelvic exams when the vast majority of them turn up nothing or a benign condition which results in a mandatory follow-up biopsy. Again using myself as an example, I have chronic cervical inflammation. It took 3 exams, an extremely painful biopsy, and lots of worrying before 3 doctors finally concluded that it was harmless. But it's not squamous cell abnormality like you see with pre-cancer conditions, and all of those painful exams I had to endure (not to mention the boredom in waiting rooms and anxiety in the interim) wouldn't have been necessary if we'd followed these guidelines.

Lastly, being able to collect data about women who have and have not had the HPV vaccine will provide valuable data as to its effectiveness. Since cervical cancer caused by HPV can take years or even decades to develop, it's too early to have a big collection of data, which is much better evidence than the smaller studies required to get the vaccine approved. Yes, it costs a little money (I think I paid something like $150 for my series? Again, less than even ONE PAP.) but it's virtually side-effect free and has been conclusively shown to reduce my likelihood of getting cancer. We'll have to wait 20 or 30 years to have exact numbers on how much my chance was reduced, but as with other vaccines, the numbers are likely to be shockingly good. There's a reason we give vaccines, and it's not so that pharmaceutical companies can make a profit: it's because they prevent millions of deaths from preventable diseases every year. And only someone extraordinarily ignorant in the history of medicine would say otherwise.

CJ- If you weren't rechecked and biopsied how would you know it was only chronic inflamation (which puts you at greater risk for infection from HPV and developing cervical cancer BTW) how would you know that was the problem? Wouldn't you rather know that was your problem and not cancer? I have worn those shoes of the waiting and anxiety. I went from an unknown abnormal to one step away from invasive cervical cancer in 6 months. That is 6 months, not years or decades. That is after 8 yrs (annual tests) of normal pap tests and negative HPV tests. If I had waited 3 yrs (or "followed these guidelines") I'd likely be bankrupt from cancer treatment or be dead. Since I was checked every year, I only had to have the affected part of my cervix removed and I'm healthy with normal paps and negative HPV tests for the last 3 yrs. There are hundreds of thousands of women in the US who will go through this every year. Please know your experience with abnormal paps is likely an exception when it comes to HPV. Did you test positive for HPV or just show an abnormality? That is the part of this article that disturbs me the most. If young women know their HPV status they can stop the spread of the virus and further reduce the number of women who would have to go through the anxiety and pain of dealing with HPV related cervical issues.

I get where you are coming from, but I ask you how you would feel about those "risks" and "benefits to the largest number of people" when it is your life or the life of a loved one that is affected? Then the greater good doesn't seem so important. Annual testing and unecissary rechecks are far cheaper and in my experience a much better alternative to finding out you have cancer that could have been prevented by an annual check up.

Sarah-

Some people die of cancer. There is no quibble about that. However, fast-growing cancer is generally preceded by risk factors. This is a recommendation for women with average risk, not women with high risk.

If you could know in advance, before subjecting yourself to a particular screening regimen, that you would be one of the few people whose life was saved (from death from one specific condition), you might say the heck with the greater good. But in many cases, it is more likely that you will be one of the larger number of people who are harmed by that test and its aftermath. If you aren't high-risk for one particular disease, how do you decide which of many diseases to be screened for and how often? Do you just roll over for every possible test at the maximum frequency recommended by anyone who may profit from the testing and follow-up? You're not going to be the lucky person whose life is saved by ALL those tests. The PLCO study has shown that if you undergo several screens annually, within a decade there's at least a 50/50 chance you will get a false positive (not even considering the *overdiagnosis* problem) and undergo risky follow-up.

Now about the "ignore the greater good" argument - I don't find it attractive, to be honest. Screening tests are often pushed on us with emotional rhetoric: well, what if YOU are the one woman in 2000 whose life is saved by annual mammography in her forties? Well, what if I am? And what if the price of my life being saved is that several other women who are overdiagnosed are temporarily or permanently disabled by needless cancer treatment; possibly one of them even dies as a result? What would entitle me to declare that they needed to endure all that so that my life could be saved - is my well-being more important than theirs?

How you weight such outcomes depends on personal values, and that's even more true for cervical cancer or "precancer", gigantically so. The biggest long-term complication of overtreatment is miscarriage. As a happily childless woman, I do not think a woman's value or happiness in life ought to depend on her ability to breed, and I believe that the life of a healthy grown woman is enormously more valuable than the life of an embryo. If I were making decisions for the whole world, I'd think it was worth a sizeable number of miscarriages to save one woman's life - though not an infinite number. But for the extremely "pro-life", who actually see the embryo and the woman as being of similar status and value, a miscarriage - maybe 1.5 miscarriages, to correct for the perhaps one-third average rate of pregnancy loss - is in some ways as great a loss as the death of a woman. Maybe even greater, since if the embryo was not otherwise naturally lost it would have had more years of potential life remaining to it. A young woman who held that belief would not be willing to accept many miscarriages per life saved; she might want to draw the line on increased frequency and aggressiveness of screening at the point when it was statistically more likely to lead to the miscarriage of one of her future children than to save her life. How would she find out what that point is? Does anyone even know? Can her doctor be counted on to ask about her religious beliefs and discuss the issue before he screens and treats her?

Zeiglo- how to do you suggest women learn if they are "High Risk" for cervical cancer so that they can be screened more frequently. It only takes 1 partner to contract HPV. It can lay dormant in your system for decades before it causes problems, and cancers caused by HPV are not always "Slow Growing"

Jane- Treatment for precancer of the cervix is usually an outpatient surgical procedure that removes the affected area and is affective the 1st time in 90% of cases. Yes you increase your risk of pre-term labor (which is different than miscarrage) by 20% each time you have this done, but that is still a fairly low risk rate. In a normal person with no other risk factors, that means an 80% success rate in pregnancies that are carried to full term. The majority of women who have been treated for a precancerous condition go on to have normal pregnancies and never have a problem with HPV again. I fail to see what the benefit is to less screening when we have well documented proof of HIGHLY affective treatment that allows women to live normal lives afterwards.

Sarah - You quote a 20% increased risk of miscarriage, which I would presume is the relative risk, i.e., it doesn't mean that 20% of women who would otherwise have had a successful pregnancy will miscarry. The absolute risk would be lower. Still, this is not a negligible increase in risk, especially when multiplied by millions of women. Many of the women treated for "precancer" would never have gotten cancer, and would have lived normal lives even if they had never seen a doctor. Those who later miscarry because they were treated have not been "saved," have not even been helped; they have suffered needless harm that will seem to many of them quite significant. The minority who would have eventually gotten cervical cancer, and further died prematurely as a result, have obtained a major net benefit even if they do end up suffering miscarriage. Nobody disputes that those women exist. The issue is that as you increase the frequency and stringency of screening of healthy people, you are likely to increase the number of people who are harmed faster than you increase the number who benefit. The only way to say that there's no such thing as too much screening is to assume that the harms count for nothing.

Jeanart,They agreed to these guidelines because of the ACA our country will be in short supply of doctors.I still believe that women who are sexually active should be tested yearly for STD's even if they are monogamous as their partner might not be.

eddie s,great comments.you seem to be well educated on this subject and I agree with you.

ron,right on and you keep up the good fight for your wife and daughter.We have a history of cancer due to a drug called DES.I've had a few doctor's not listen to me and I went and found another doctor.Prevention is key to a long and healthy life and the sooner cancer is caught the better the outcome.You wife and daughter are lucky to have you in their corner in regards to women's health.

Most pre-cancerous cells do clear on their own; the immune system actually can attack many cancers before they have a chance to grow very much. That doesn't mean, of course, that the condition won't come back.

I hear you on the over-testing. A couple of years ago my doctor saw that I had eversion (a condition where the more delicate cells from the inner part of the cervix start growing toward the outside) and some inflammation, and sent me to have what turned out to be an extrememly painful colposcopy. It showed nothing abnormal, only inflammation. It's been two years, and every year since then I've had very painful pelvic exams because the inflammation is persistent and results in chronic bacterial infections. However, there's been no evidence at all of pre-cancerous conditions, and in fact the whole thing is probably hormonal in nature. A 3-year exam would likely be fine for someone like me and provide a little relief from the anxiety over the inevitably painful exam.

Sunflowers13,Please find another doctor.It doesn't clear up on it's own and the cold knife biopsy should not be the first test after a negative pap.I know as I've had so many biopsies,surgery etc. I could right the book on false positive paps and the drug DES. Be aware that those looking over your tests aren't always the brightest bulb.Next time you get a negative test make your doctor retake the pap first.

Half the planet has or has had the virus that causes genital warts. It usually goes away over time and is usually not harmful. Young people simply are not going to take a vow of celibacy or isolate themselves sexually as if they had AIDS or leprosy because they are told they have HPV. Won't happen. But if you believed that they would, you should argue for universal testing of men. Cervical cancer is a relatively rare cancer, but it is more common and more often fatal than penile cancer (which can also sometimes be caused by HPV). Therefore, a man who has a potentially harmful strain of the virus is more likely to cause harm to a future female sex partner than a woman is to cause harm to a future male sex partner.

Jane, I do not believe people would be celebate, but they would take more precautions. Be more selective, at least be able to inform their partner they have the virus. And it isn't half the planet it is about 80% of the planet. That number is so high BECAUSE people don't think it is serious enough to be worried about. Also, if you knew as much about HPV as you seem to be putting out here, you'd know a man cannot be tested for HPV like a woman because there is no HPV test approved for men. And though it is "USUALLY" not harmful, is harmful frequently enough that at some point it was recomended that women get annual exams and testing done. Again, I am one of the ones who would have been harmed if I'd waited 5 yrs, or even 3 yrs as the current guidelines recomend.

The most objective organizations state that testing of young people should NOT be done, and for logical reasons. Look, let's consider Epstein-Barr virus. It causes mono. Most of us have had mono and felt like crud for a few weeks, then got better. But there is also some evidence that chronic infection can in some people cause or increase the risk of more serious illnesses. Should everyone who has had mono refrain from ever again so much as kissing another human before "informing" him/her of their potential taint? A few thousand people per year die of cervical cancer, and NOT all of those are caused by HPV - if they were, we wouldn't be told that even HPV-negative women still need to keep getting Pap smears throughout their lives. This isn't AIDS. We live in a world of cooties, many of which are much worse than HPV - nobody disputes that there are good reasons to avoid casual sex.

jane,State your source or what medical degree do you have.Most people have not had mono for one thing.Every sexually active female should be tested yearly for STD's.One pap test yearly has been known to save lives.I have been told this by several gynecologist/oncologists.

There should be a way for women to pay out-of-pocket for more frequent exams. If they need insurance coverage, just create the WomensSmartPlus plan and charge more for the additional services.

there are health clinics out there for people who are living under the poverty line that do the exam for next to nothing if not for free.there is also a medicaid buy in program for those who need more than testing.there are so many resources out there to help people out.you just have to look.where there is a will there is a way,especially if it involves your life.

There's no contradiction. Most people get infected with some strain(s) of HPV. Most HPV infections are temporary, and even chronic infections are usually harmless. There is no value in making a majority of healthy young people feel contaminated and at-risk by labeling them all as carriers. But if certain strains hang around long-term, they eventually cause cancer in some carriers. The vaccine is intended to reduce that risk, and it very likely will. But it does not get rid of the virus if you already have a chronic infection before you get it, so if you think it's worth the money to gain a long-term reduction in the risk of an already uncommon but nasty disease, you must get the vaccine before you're exposed to the relevant strains of virus.

There is no value in making a majority of healthy young people feel contaminated and at-risk by labeling them all as carriers.

So we don't test because we don't want young people to "feel contaminated"? We only make them "feel contaminated" if they happen to be carrying one of the four most prominent, but not exclusively responsible strains associated with cancer?

That sounds kind of messed up, to me.

But thanks, Jane, for attempting to give some explanation for what appears to me to be a glaring contradiction in our current health care cannon.

You are very welcome. 80% of us are infected at some point with HPV. Exposure is almost universal among people who have any type of intimate contact whatsoever with others. No matter what strain you have, it usually goes away. The National Cancer Institute estimates that this year, 12,170 women will be diagnosed with cervical cancer and 4220 will die of it. The age-adjusted incidence rate is 8 per 100,000 per year. That makes it a fairly rare disease. The median age at diagnosis is 48 with only 14.2% diagnosed before the age of 35, and for those who die, the median age of death is 57.

If you are a young person - I find some people's exclusive focus on women odd - who has been exposed to this virus, the odds that it will leave your body altogether are high, the odds that it will harm you are minute, and if you are one of the rare people who develop cancer, it's likely to happen only after years or decades, not next week. You do not need to spend your twenties scurrying about having tests and retests and retests out of fear for your own health.

Do you need to do it because you must swear off all intimacy until you have cleared the virus so that you do not expose others to your deadly contagion? Well, what if that turns out to be forever? Since HPV-induced cancer is rare (NCI estimates that in 2012 there will be 1570 cases of penile cancer and 310 deaths), your potential partner is very unlikely to be harmed. Marrying a person who will insist on eating a lot of fast food will reduce your life expectancy much more than marrying a person with genital warts.

Of course, whether you have HPV or warts or not, it is better to avoid having many casual sex partners, but there are several benefits to doing so that seem to me much more important than avoidance of HPV transmission.

Again Jane, There is no test for men for HPV. That's why the focus is so much on women. And I'm sorry if you find out early in life you can make lifestyle changes to boost your immune system through diet and exercise to keept he virus suppressed so that you don't die at 57... which is a pretty damn early age to die IMO.

Also the strains of HPV that cause warts ARE NOT the same ones that cause cancer.

www.thehpvsupportnetwork.org should clear up a lot of the misinformation you are putting out there. Yes some of what you are saying is true, but a lot if it just plain wrong.

I'm no expert on this - as far as I know, you are not either - but the organizations that are recommending NOT testing young people and labeling 80% of them as contaminated and high cancer risks are experts. There is no reason to inflict cancerphobia on 80% of our young people, having them scurrying around in their 20s trying to "boost their immune systems so they don't dieeee!" The large majority of them will clear the virus and be at no risk from it whatsoever. Why make them spend what should be the best years of their lives living in fear?

Jane,You are certainly no expert on this subject.At 62 years old and I have never been infected with an HPV or any other sexually transmitted disease.I've had pap smears since 18 years old and in my mid twenties was diagnosed with cervical cancer due to DES.Pap smears saved my life.Please read up on DES and STD's.Your knowledge of this subject needs honing to say the least.Judging by your posts I'd say that you are a professional blogger who is being paid by the insurance companies.If I'm on the wrong track then what is it that you detest so much about women that you are trying to convince women when they are under 30 to risk their lives by skipping a cheap and simple test?

I'm sorry to hear about your loss. But you don't know that getting her pap smear would have saved her. Many cancers have slow-growing types and very fast aggressive types. The slow types get found by annual screens, but wouldn't have caused any harm in the next year anyway, and the fast types have often spread so that they are incurable by the time they are detectable with screening. That's why mammography only reduces the breast cancer death rate by about 15%. Your aunt's cancer might have taken only a few months or weeks to go from visible to metastatic. It seems like blaming the victim to presume that she would have been one of the minority for whom the 12-month interval would have been exactly right to be lifesaving - "if she had done what she was supposed to, she wouldn't have died." You can never know that.

Jane- You don't get it do you? Just because it "usually" isn't a problem does not give comfort to those of us for whom it is in fact a problem. We know the statistics and risks because we've throughly researched it. We live with the reality of being one of the "Rare" cases daily. I am so passionate about this because I don't think ANY woman (or man) should have to go through this. A relatively cheep annual test is not a horrible thing to have to go through. THe miscarrage risk of having a high level lesion treated is fairly minimal. It only increases your risk of miscarrage by 20% and 1 treatment has a 90% sucess rate. If you plan to go on to have children after treatment your GYN should know that you've had this issue and your pregnancy will be carefully monitored. Most women go on to have normal pregnancie after treatment. If you want to call me on the "Usually" I"m using here go for it. But those women know they did something to prevent cancer and have a lower risk of DYING because of it.

Ah, "careful monitoring" - it's fascinating how often one intervention cascade leads to another in the medical industry. Look, I may not get your "it," but you also don't get my "it," which is that your personal experience does not prove that highly aggressive screening is best for everyone at the population level. I have a relative and a friend who have suffered recurrent miscarriages; both find it very painful emotionally. This is a real harm. Let's ignore the fact that some screens - like those for ovarian cancer - don't reduce overall death risk because the extra procedures done kill as many as they save. You seem to assume that avoiding "DYING" is the ultimate value that trumps all others. I assume that people also care about not suffering or being disabled, and that if a screening test inflicts more than a certain amount of suffering or disability per year of life saved, it may not be worth it. After all, I'm going to DIE of something sooner or later anyway, so I'd like to have a good life while I'm here. This is a value judgement, either way. Your values fit with typical allopaths' values much better than mine, but they are not thereby obviously superior.

Edit - What "usually isn't a problem"? Your comment, and my initial response to it, have nothing to do with Laura's issue. The assumption is that whenever someone who dies of an aggressive cancer hadn't gotten screened on the most frequent possible schedule, they'd have been saved by more screening. This is often not true, as shown by those who develop "interval cancers" in the short period between screenings, or those who have cancers caught in a frequent screen and end up dying anyway. And I didn't use the word "usually" or say that aggressive cancer "isn't a problem" - of course it is - so I really don't know what you intended to say.

Sarah,Jane is a paid blogger I believe or she really detests women.If she spent half the time educating herself on women's cancer issues than she does trying to convince women that paps aren't necessary she would embarrass herself.I've been down the cervical cancer road and can tell you that she is wrong.Get your pap yearly.My mother will be 88 this year due to her cancer being caught by having a pap smear.If she would have listened to the first two doctors who ignored her symptoms she'd of been dead in her 40's. And to Jane,I have several oncologists that disagree with you.