I have heard that I no longer need to get a Pap every year. Is that true?

Written by Dr. Jonas – Kalispell OB/GYN

That is a great question! But before we jump into the answer, the most important thing to remember is that you still need to have a yearly exam. Your Pap smear constitutes a very small part of the annual health exam performed by your health care provider. And understand that a Pap smear is not the same as a pelvic (speculum and internal) exam. The speculum exam allows your healthcare provider to see your vagina, cervix, opening to your bladder etc. An internal exam allows him/her to confirm that there is no obvious growth or abnormality of the ovaries, uterus or other abdominal organs. Therefore, these should still be done. The Pap smear is when cells from your cervix are collected on a brush and placed in liquid to be sent to the lab. These cells are then inspected under the microscope by the Pathologist, his/her technologists, and often a computer as well, looking for precancerous or cancerous changes. Although it is true that these cells may not need to be collected and sent to the pathologist as often, do plan on continuing your yearly visits.

In November 2012, 21 different women’s health care professional societies and organizations published new, mutually agreed upon guidelines regarding the timing and nature of cervical cancer screening. These new recommendations are changing what we as healthcare providers consider the standard of care and what we recommend to our patients. The American College of Obstetrics and Gynecology, the leader in women’s health care nationally, participated in developing the guidelines has formally endorsed them.

The changes came about due to our evolving understanding of how Human Papilloma Virus (HPV) affects cervical tissue, and newer information about the natural progression, or lack of progression, or minor changes. The goal of these new guidelines is to maintain a high level of safety from cervical cancer, while decreasing the harmful effects from over treating minor changes that will sometimes regress if left alone. Moderate to severe precancerous changes rarely regress however, and these changes require treatment to prevent progression to cancer.

The new recommendations are generally as follows:

• Pap smears should not begin until age 21.
• Between the age of 21 and 29, Paps should be done every 3 yrs and HPV testing should not be part of the routine testing in this age group.
• From age 30-65, Paps should be performed either alone every 3 yrs or with HPV testing every 5 yrs.
• Paps should stop at the age of 65 if you have had routine screening in the past 10 yrs, with normal results within 5 yrs.
• Paps should stop after hysterectomy if your cervix was taken, your previous screening is up to date a normal, and the surgery was not due to precancerous or cancerous change of your cervix.
• If you have had moderate to severe precancerous changes of your cervix, you should continue to be tested until 20 yrs after treatment.
• If at any time your provider sees something abnormal on your cervix, vagina or vulva, a sample of the tissue may be needed even if it is not yet time for your Pap smear.
• These recommendations sill apply for women who have had the Gardasil vaccination. This may change in the future.

These recommendations do not apply if your immune system does not function properly, if you have HIV, if you have had cervical cancer, or if your mother took Diethylstilbestrol (DES) while she was pregnant with you. In addition, depending on your Pap or HPV results in any one year, the timing of follow-up testing may change.

The newer liquid-based Pap smears allow the HPV testing to be done from the Pap smear sample. In addition, many sexually-transmitted diseases can be tested from the same sample, if indicated.

In conclusion, there is a new approach to the timing of Pap smears. Depending on your age, HPV testing may be recommended with your Pap to improve the ability to pick-up precancerous or cancerous changes. Your personal history will dictate what screening schedule is best for you. These are not “one size fits all” guidelines. You still should go in for a yearly health exam with your provider and a pelvic exam will continue to be part of that visit in most cases. Talk with your physician, or other healthcare provider, about your specific history and the two of you can reach a plan that is most appropriate for you.

If you would like to read more on this topic or other topics of interest in women’s health care, I would recommend 2 great, reliable sources of patient information: http://www.acog.org/ForPatients, and http://www.uptodate.com/contents/table-of-contents/patient-information/womens-health-issues.

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Dr. Jonas is a regular contributor to Health Care Answers at 406 Woman Magazine.  The original article appears online in their Oct/Nov 2013 issue.

PLEASE NOTE: This information is not intended to be medical advice.  It is general health information and does not take into account your particular health status nor is it a substitute for personal medical care.  Kalispell OB/GYN shall not be liable for any damages arising out of the use of the content herein.