The number of cervical cancer cases diagnosed annually has gone down markedly over the past 30 years, a drop attributed to cervical cytology screening (the Pap smear). The American College of Obstetrics and Gynecology recently changed its guidelines for cervical cancer screening. Dr. Diane Boykin of St. Agnes Hospital discusses what you need to know about the new guidelines.

* The new guidelines state that all Pap smears can begin at age 21. This is a subtle change from the previous recommendation, which had screening begin by age 21 or one to three years after the onset of sexual activity. The change represents the low incidence of cancer in youths. Abnormal Pap smears and cervical dysplasia do occur in the adolescent. All sexually active adolescents should still have an appointment with a pediatrician or gynecologist to be screened for sexually transmitted diseases and have safe sex counseling and discussion about contraception.

* Cytology screening should be performed every two years for women ages 21-29 under the new guidelines. For women 30 and older, the Pap smear might be performed every three years if there are three consecutive normal Pap smears. These recommendations don't apply to high-risk women such as those who are HIV-positive or immunosuppressed. Despite these recommendations for the cervical cytology screening, there are still many reasons an annual exam should occur. Often during the annual exam, other health issues are addressed.

* The screening may cease at ither age 65 or 70 if there are three or more normal Pap smears leading up to that age, and no abnormal Pap in the past 10 years. For women who have had a hysterectomy for benign disease, the Pap smear may cease if there is no previous history of cervical dysplasia. This group of patients needs to have a discussion with their doctor. Many women have had hysterectomies but the cervix is still present. For those individuals, Pap smears would continue to at least age 65 to 70.

* There are several high risk factors associated with cervical cancer. The first is lack of screening - in 50 percent of cervical cancer cases, cytology screening has never been done. In another 10 percent of cases, screening had not been done for five years before diagnosis. Other risk factors include human papillomavirus infection, smoking, early onset of sexual activity, multiple sexual partners and being HIV positive.

* For women 30 and older, persistent HPV infection is of concern. The virus is an associated cause of cervical cancer. Most women are exposed when sexually active. Most will clear this viral infection spontaneously. For those with persistent HPV infection, even with a normal Pap smear, closer observation is warranted. These are individuals who probably should still have annual Pap smears. The HPV test can be done at the time of routine cervical cytology screening. It is recommended once every three years after the age of 30.

For girls and women ages 9-26, there is an HPV vaccination that can be given. The vaccination protects against two strains of the HPV infection associated with 70 percent of cervical cancer cases.