ACOG: annual Pap not for all women: intervals of 2-3 years.

The annual Pap smear that has become a ritual for most American women is becoming a more risk-directed test and is no longer recommended by the American College of Obstetricians and Gynecologists for young, sexually active teenagers or healthy women over age 30.

Instead, cervical cancer screening will begin later in a young woman's life and then be scheduled on the basis of her age, previous test results, and other risk factors. For many patients, this will mean that cervical cytology screening will take place at intervals of 2-3 years rather than every year.

Guidelines in an evidence-based practice bulletin issued in July represent the most sweeping changes in a decade in ACOG's policy concerning cervical cytology screening. The changes largely conform to recent guidelines issued by the American Cancer Society (ACS) and the U.S. Preventive Services Task Force.

Dr. Stanley Zinberg, ACOG's vice president for practice activities, said the new recommendations reflect enhanced knowledge about the development of cervical cancer and improvements in screening technology.

For example, it is now known that cervical dysplasia takes several years to develop after infection with human papilloma virus (HPV), so ACOG is recommending that a young woman's first cervical cytology test be performed at age 21 or approximately 3 years after first sexual intercourse, whichever comes first.

Longstanding ACOG recommendations advised screening young women for cervical cancer at the onset of sexual activity or at age 18, whichever came first, and then screening annually for most of their lives.

Dr. Alan Waxman, who helped write the ACOG guidelines, said in an interview that the guidelines make scientific sense but will require a reeducation of women who have come to believe that the Pap test is the sole purpose of an annual examination.