LEAWOOD, Kan. (Annals of Family Medicine) -- Despite recent recommendations that low-risk women need Pap smears only every three years after three consecutive normal Pap smear results, a study in the current issue of Annals of Family Medicine reports that women might be reluctant to engage in risk-based cervical cancer screening.

"Most of the women we interviewed were firmly set against reducing the frequency of Pap tests," said the study's lead author, Mindy Smith, M.D., M.S., from the Department of Family Practice at Michigan State University. "The habit of having an annual visit to a clinician for a Pap smear appears to be firmly entrenched and viewed as an integral part of a woman's health care. It is a habit that has been socialized over many years and will likely be difficult to change."

In a series of eight focus group interviews, women offered a variety of reasons for believing that yearly Pap tests are desirable, including the belief that Pap tests are successful in reducing cervical cancer mortality, that some Pap tests are inaccurate and therefore need to be repeated, a suspicion that recommendations for reducing the frequency of testing were driven by organized medicine and the insurance industry, a mistrust of clinicians, and vivid personal experiences with cancer.

Approximately 16,000 new cases of cervical cancer are diagnosed each year, and approximately 4,800 women die from the disease annually. According to the American Cancer Society, between 1955 and 1992, the number of cervical cancer deaths in the United States dropped by 74 percent, in large part due to the increased use of the screening test and early detection.

Many groups, including the U.S. Preventive Services Task Force, American Cancer Society and American College of Obstetricians and Gynecologists, now recommend that low-risk women need Pap smears only every two to three years after three consecutive normal Pap smear results. They point to data showing little evidence that women who receive annual screening are at significantly lower risk for invasive cervical cancer than are women who are tested every three to five years. Combined data from a series of eight studies involving more than 1.8 million women showed that annual screening reduced the cumulative incidence of cervical cancer by only 2.7 percent compared with screening at a three-year interval. Proponents of triennial testing also point to important economic considerations. The U.S. Preventive Services Task Force points out that annual testing could double or triple the total number of smears taken on more than 92 million American women at risk, yet provide only limited added benefit in lowering mortality.

"We hope that the findings from our study will help enlighten the current debate over the frequency and timing of Pap tests based upon risk of cervical cancer," said Smith. "As this study makes clear, health-care providers face significant barriers to putting risk-based screening recommendations into practice."

The researchers suggest that those planning to limit a screening test that has been so well incorporated into popular culture need to take women's perceptions and concerns into account.

"Women need reasurrance," said Smith. "The women we interviewed were very distrustful of the rationale for the suggested changes, suspicious that reducing the frequency of testing is motivated by concern for cost rather than quality of care," commented Smith.

The researchers also note that women's reluctance to adopt a risk-based screening approach appears to stem in part from a lack of knowledge about the risk factors for cervical cancer, its natural history, and the effectiveness of annual compared with triennial screening. But, they point to a strong self-advocacy theme, which emerged in the interviews, as an opportunity for those trying to educate and influence women's beliefs.

"The women we interviewed expressed a strong will to take responsibility for their own health care and obtain the information they need to make informed health decisions," said Smith. "Policy makers and providers should take advantage of women's proactive approach to health care by providing educational materials that explain the facts about cervical cancer and screening for the disease."