FORT RUCKER, Ala. -- Over the past several years there have been many changes in the recommendations for cervical cancer screening and this has caused some confusion in women and health care providers as well.

With cervical cancer being the second most common cancer in women worldwide, it is imperative that routine Pap smear screening be done based on individual risk factors and the most up to date evidence based recommendations.

In the past, cervical cancer screening was started at the onset of sexual activity or age 18, whichever occurred first. This practice led to aggressive treatment of precancerous lesions that all too often caused infertility problems or preterm labor for women.

Later studies have shown that these precancerous lesions in young, healthy women spontaneously regressed without treatment. Recent clinical trials have shown that cervical cancer typically occurs in women 21 years old and older, not in these very young women. Based on this clinical evidence, the decision to postpone cervical cancer screening until age 21 was made.

The American College of Obstetricians and Gynecologists does recommend that in women younger than 21, Pap screening should start three years after their first sexual encounter. However, it is important to note that a pelvic exam and testing for sexually transmitted infections should begin once sexual activity has begun.

If a Pap result returns and is abnormal, no biopsies are taken unless there is suspicion that the patient might have moderate dysplasia or more severe cellular changes.

In women between the ages of 21 and 30, if they have had three consecutive negative Pap tests, they may extend the time between screenings to every two years.

Another recent change is to extend the Pap smear screening interval to every three years in women ages 30 and older who have never had cervical dysplasia (precancerous cells) and who have had three consecutive negative pap smears.

Cervical cancer is most strongly associated with infection with Human Papillomavirus types 16 and 18. However, there are 13 high-risk types of HPV and prolonged infection with any of these 13 types of HPV can lead to cervical cancer.

By adding an HPV test to Pap smear screenings in women 30 and older every three years, cervical cancer testing is much more specific and sensitive, resulting in more confidence in the results. This test is currently available at Lyster Army Health Clinic.

It is important to understand that annual well woman exams should continue even without a Pap smear screening. There are a number of other gynecologic problems that are screened for during this annual appointment. Screening for vulvar, uterine, ovarian and breast disorders should continue on a regular basis depending on the age of the woman. Screening for sexually transmitted infections should continue annually from the onset of sexual activity through age 25 regardless of risk factors, according to the Centers for Disease Control.

People can schedule annual well woman exams by utilizing Tricare Online or by calling 255-7000. People can also seek help or information on other gynecologic problems or concerns as needed.