The American College of Obstetricians and Gynecologists has published new guidelines for cervical cancer screening. The new guidelines are similar to recently revised recommendations of the American Cancer Society and the U.S. Preventive Services Task Force. According to the new guidelines, women will no longer need annual testing for cervical cancer, and screening can begin at an older age than previously recommended.
The recommendations are outlined in an evidence-based practice bulletin, "Cervical Cytology Screening," and will be published in the December issue of Obstetrics and Gynecology.
The recommendations include the following:
Cervical screening should begin approximately 3 years after a womans first sexual intercourse, but no later than age 21 (Previous recommendations called for screening by the onset of sexual intercourse or by age 18).
Women younger than age 30 should undergo annual cervical cytology screening (i.e., Pap smear).
Women age 30 and older who have negative results on three consecutive annual cervical cytology tests may wait 2 to 3 years before rescreening.
Women may opt to receive both a cytology test and a test for human papillomavirus DNA. Women who test negative should be rescreened no more than every 3 years. If one of the tests is positive, more frequent screening will be needed.
The practice bulletin is available from the American College of Obstetricians and Gynecologists at http://www.acog.org.
See also News, Vol. 95, No. 6, p. 424, "Guidelines Recommend Less Frequent Screening Interval for Cervical Cancer."
Long-Term Survivors of Acute Lymphoblastic Leukemia Can Expect Normal Life
People successfully treated for childhood acute lymphoblastic leukemia (ALL) without radiation therapy who have survived 10 years or longer without disease recurrence have nearly the same life expectancy as they would have if they never had cancer, according to a new study.
ALL is the most common childhood cancer. It is usually treated with chemotherapy; however, many children will also undergo cranial irradiation to prevent the cancer from spreading to the central nervous system. To determine the long-term effects of treatment on survival and on socioeconomic factors, Ching-Hon Pui, M.D., of the Department of Hematology-Oncology at St. Jude Childrens Research Hospital, Memphis, Tenn., and colleagues examined the medical records of 856 children with ALL treated at St. Judes between 1962 and 1992.
A total of 597 patients were treated with radiation therapy and 259 were not. Children who had received radiation therapy had a higher risk of a second neoplasm compared with the nonirradiated group20.9% versus 0.95%, respectively. The death rate for the irradiated group was only slightly higher than the expected number of deaths in the general population, and the death rate among those in the nonirradiated group did not differ from the population norm.
The investigators also looked at several socioeconomic factors. They found that rates of health insurance coverage, marriage, and employment among those in the nonirradiated group were similar to the national averages. Those in the irradiated group had higher unemployment rates than the national average, and women who had received radiation therapy were less likely to be married.
The study was published in the August 14 issue of the New England Journal of Medicine.
Study Finds Increase in Breast Cancer Incidence, Death Among HRT Users
A study of more than one million women in the United Kingdom confirms past findings that users of hormone replacement therapy (HRT), both past and current, are at an increased risk of invasive breast cancer.
The results of the Million Women Study, published in the August 9 issue of The Lancet, also found that women who use HRT have a higher risk of death from breast cancer than nonusers, and that the type of HRT taken determines a womans risk of breast cancer. Use of combined estrogen and progestin hormone replacement therapy was associated with a substantially greater risk of breast cancer than use of estrogen alone.
Among current users of HRT, risk of breast cancer increased with duration of use. The authors estimate that 10 years of estrogen-only HRT use results in five additional breast cancers per 1000 women, and 10 years of combination HRT use results in an additional 19 breast cancers per 1000 women. They also estimated that current users of HRT have a 22% increased relative risk dying of breast cancer than nonusers; however, the authors note that there is not enough data to reliably estimate the excess deaths resulting from HRT use. Past users of HRT did not have an increased risk of breast cancer or a greater risk of death from the disease. Women who used estrogen and progestin HRT had a higher risk of breast cancer than women who used estrogen alone or tibolone (synthetic HRT).
See also News, Vol. 95, No. 1, p. 9, "NIH Workshop Tries to Create Consensus on HRT Use," and Vol. 94, No. 15, p. 1116, "The End of an Era? Study Reveals Harms of Hormone Replacement Therapy."
Linda Wang and Katherine Arnold
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