Pap guidelines...

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Hi--I'm sure this topic has come up on this site in the past, but couldn't figure out how to search for previous threads....so sorry for a repost if that's what this is...

Wondering if I can get your input on the pap guidelines, and what you all follow in practice...I'm a new FNP and learned in school the guidelines are to not start pap/pelvic in women younger than 21...and at that point, paps can be done every 1-3 years with most practices doing them every 2 years unless there are abnormal paps that come back, which would warrant more frequent tests...

The office I've started working at does paps annually still and does them on teens who are wanting to start birth control....? Is the 2 year thing something that's not actually done in practice or what? When I've asked the other NP why she does them every year, she says that she feels more comfortable doing them every year bc things can change in that time....which I understand, but then what's the point of having a guideline? I understand doing a pelvic exam every year, but what do you all do about the pap? And especially in teens?

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Specializes in Peri-op/Sub-Acute ANP.

There is a free app called ePSS that gives you all the AHRQ guidelines.

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No paps until after 21 years old, every 3 years. I would keep with the guideline and practice that way.

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The current guidelines are slowly being accepted. At this point insurances are still paying for annual pap smear, so some offices continue to do them annually for money and patient preference. The reason that guidelines are do not reccomend younger than 21 and less frequently is that most healthy individuals will clear the infection. Cervical cancer is usually slow growing, so it should be detect if screen for every few years. Studies showed that frequent more screening led to excessive invasive treatment without waiting to see if mild cases would resolve on their own. Cone procedures and multiple leeps affect the cervix structure and can result in future high risk pregnancy related to incompetent cervix. Convincing the patients can be the hardest part. Sorry I do not have specific references for the research but that is what we learned in school was the reason behind the changes in the guidelines.

I just started at a practice that requires that everyone get a pregnancy test to recieve birth control. At Contraceptive Techonology, I learned the research shows you only need a good history and BP. No pelvics either. There was an article just published about the fact pelvics may be overly used as an annual screen and provide patient with false reassurance. There have been some studies I believe in other countries that show COC used as an OTC are safe but I do not think that is going to happen in the US anytime soon. Chlamydia screening is reccomended to be done on everyone sexually active under 25 due to the high risk of undiagnosed infections and the long term consequences (infertility and PID). If you can do urine screen, there is no need to do a speculum exam to do the swab.

Hope this help :)

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Specializes in Community Health.

I agree with the above post. Evidence based practice is the way to go. Current recommendations are also leaning towards Pap smears every 5 years for women >30 yrs of age if she had 3 normal pap smears (strong recommendation).

Grade A recommendation is every 3 years.

http://www.cdc.gov/cancer/cervical/pdf/guidelines.pdf

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Every 5 years is with HPV DNA testing for over 30 years. Cytology alone is different.

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Specializes in Community Health.

Correct... according to this chart. Just went to a conference and was told newer recommendations from ASCCP will be cytology q 5 years.

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Thanks so much! I feel like I've been in the Twilight Zone or something...like I know all of these guidelines and recommendations and why they are what they are, etc, but this office does the pap guidelines from the 90s like without beating an eyelash, and I started to question myself....Duh....just go straight back to the evidence-based info and lead the way! Thanks...

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Yeah, I hear ya. One preceptor was upset with me a few years ago when I looked up the ePSS guidelines for a young woman seeking birth control...she wasn't interested in doing anything other than what she learned in he 1990s. *sigh*

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Specializes in Community Health.
Correct... according to this chart. Just went to a conference and was told newer recommendations from ASCCP will be cytology q 5 years.

Addendum for current recommendations:

http://www.medpagetoday.com/OBGYN/GeneralOBGYN/38321

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Great--thanks...

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I just found a Pap App in Google Play. It has summaries of evidenced-based clinical guidelines for pap and colposcopy results. Very convenient for looking up what to do with tricky patients.

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