We all know we need to get a Papanicolaou smear (pap smear) in an effort to detect cervical cancer. In the United States, the 70 percent decrease in cervical cancer mortality over the past five decades is attributed to pap screening.
When do I need a pap smear?
I was speaking with a woman in my office the other day, who was surprised to be told by her doctor that she didn’t need a pap smear. While pap smear screening was initially implemented as an annual test, subsequent research in eight countries supported recommendations for screening once every three years. This research led to recent changes to screening guidelines in 2012. Some medical organizations are even pushing for more reduction—screenings once every five years.
- Screening begins at age 21. *Regardless of sexual activity.*
- From 21-65 years of age, you need a pap every 3 years.
- After 65, you can stop screening (based on your screening history).
- Frequency guidelines change if you have an abnormal pap smear.
- Guidelines are more frequent for women who have HIV.
- (obtain a Pap test twice in the first year after diagnosis of HIV infection and, if the results are normal, annually thereafter.)
What about HPV co-testing?
- You don’t need to be co-tested for Human papillomavirus (HPV) if you are under the age of 30.
- Women who have received the HPV vaccine should still be screened.
- After 30, you want to be co-tested (pap plus HPV) every 5 years.
- Ask your doctor about getting screened for other sexually transmitted infections (STI). For example, the CDC recommends annual chlamydia and gonorrhea screeningsin women under the age of 26.
- Screening guidelines for older women are based on risk behaviors and demographics.
Why less and not more?
It is important to understand the relationship between guidelines and clinician practices. Research informs guidelines, which should in turn inform medical practices. Historically, annual screening has led to very little increase in cancers prevented. Pap smear guidelines were put into place in order to reduce patient burden and to reduce healthcare costs related to screenings in America.
What are we talking about when we say “patient burden?” Physical discomfort, anxiety, and money spent to deal with benign, temporary infections. Cervical cancer in adolescents under the age of 19 is very rare and lesions often regress on their own in adolescents under the age of 21. Persistent infection is needed for the development of cervical cancer. Cervical cancer is also rare in older adults who have been previously screened.
Less does not mean none!
It is important to note that these guidelines are not intended to diminish the importance of cervical cancer screening.
Also, a pelvic exam and a pap smear are not the same thing; all women should maintain regular healthcare visits.
Final decisions about your pap screening routine should be based on a discussion of the benefits, risks, and limitations of cervical cancer screening with your providers. You might also want to check what your insurance covers in terms of screenings.
Here is a quick summary by age:
• Under 21: No Pap smear necessary, regardless of sexual activity. No HPV screening.
• 21-29: Pap smear every three years. No HPV screening.
• 30-65: Pap smear every three years, or a Pap and HPV test together every 5 years.
• Over 65: No screening if there is no previous history of cervical cancer.