To Pap or not to Pap

To pap or not to pap?  

Written by Dr. Teng 

The guidelines for cervical cancer screening have changed several times in the last decade.  You may have been told by someone that you need your pap test every year, or you may have read somewhere else that you don’t.  You may be wondering why people are telling you conflicting things, and I don’t blame you.  Hopefully after reading this post, you will have a better understanding of the purpose of performing a pap test and how often you should have one.


 

So what is the point of the pap test?

The papanicolau (pap) test, commonly called the pap smear, has been the standard screening tool used to detect precancerous lesions of the cervix and cervical cancer.  It is usually performed at the annual well woman visit.  In the past, the recommendation was for women to have yearly pap tests with their regular checkups.  Over the years, the recommendations have evolved to reflect our understanding of the link between the human papillomavirus (HPV) and its effects on the cervix.  HPV is a virus transmitted through sexual contact that has been associated with the development of cervical cancer and genital warts.  HPV infections of the genital tract often do not cause any symptoms, and most women who have an HPV infection may not even know about it.  Luckily, most HPV infections are transient and will be eliminated by the body’s immune system in an average time of 8 months.   Only a small fraction of women with certain high-risk types of HPV will develop cervical abnormalities, and an even smaller amount will develop cervical cancer.  Since 2006, the ability to test for high-risk types of HPV has allowed us to identify patients needing close follow up and more frequent testing.  Persistence of high risk HPV infection can lead to precancerous changes, which can be treated.

So how does this all translate into the timing of pap tests?

  • The American Society for Colposcopy and Cervical Pathology (ASCCP) in 2012 published updated guidelines for screening, which have been adapted by the American College of Obstetricians and Gynecologists (ACOG) and the American Cancer Society (ACS).
  • Start screening all women at the age of 21, regardless of prior sexual activity 
  • Women between the ages of 21-29 need a pap test every 3 years 
  • Women ages 30-65 need an HPV and pap test every 5 years, or pap test alone every 3 years 
  • Women ages 65 and older without any history of high-risk changes can stop pap tests

 

 What if I have an abnormal result?

The results of the pap test can range from slightly atypical cells, which is extremely low risk, to more severe changes that may be more high risk.  Depending on the result, you may need more frequent screening with a pap test and/or HPV test.  Your doctor may also recommend a colposcopy, which is a diagnostic test usually performed in the office.   He or she may take biopsies from areas of the cervix that appear abnormal.  It is important to have a thorough discussion with your doctor regarding the results and the recommended follow-up, and to voice any questions or concerns that you may have. 

 

Final thoughts…

Although these guidelines are based on the most up to date research available, it is our job as the physician to use our clinical judgment to assess each patient and determine what the best plan of care is given her history and current situation.  The pap test is one of the most effective screening tests out there that has statistically been proven to decrease rates of cervical cancer.  In the last 30 years, due to the implementation of routine pap screening, the number of cases of cervical cancer in the United States has decreased by more than 50%!  We hope to continue this trend with further research and patient education. 

 

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