Recent changes to Pap guidelines may have you wondering when exactly you need to have a pap smear and in turn, how often you really need an annual exam with your gynecologist. Here I’m going to review the new pap guidelines so you can determine if you are up to date! Of course, every patient should check with their physician about what they recommend regarding the timing of cervical cancer screening because some specific populations may have different recommendations. These are just the general guidelines.
Pap smears are a screening test for cervical cancer. They have helped decrease the incidence of cervical cancer by more than 50% in the last 30 years. Over the last decade we’ve also begun testing for HPV (or Human Papillomavirus) which is by far the most common cause of abnormal pap smears and cervical cancer. It is an incredibly common sexually transmitted virus that can be spread by genital to genital contact but also oral to genital and manual to genital contact. It has been estimated that 75 to 80 percent of sexually active adults will acquire a genital tract HPV infection before the age of 50. Luckily, most HPV-infected women, especially younger women, will mount an effective immune response to the virus and will never develop dysplasia or cancer.
HPV is not like herpes —YOU CAN GET RID OF IT! The amount of time it takes to get rid of the virus varies but most experts think it takes an average of 8-24 months. Women with persistent HPV infections are more likely to get dysplasia and if it goes undetected or untreated, over time it can develop into cancer. HPV infections of the cervix do not cause symptoms and can only be detected by pap screening. Unfortunately we don’t have a cure for HPV, but vaccinations are available and FDA approved for girls and now boys ages 9-26. More on HPV is sure to show up in future blog posts, so stay tuned!
The American College of Obstetrics and Gynecology (ACOG) recommends starting pap screening at age 21. Previous guidelines advised starting pap screening within 3 years of sexual activity, but since so many young women are newly sexually active and have transient HPV infections, they found they were over testing this population and finding low grade abnormalities that caused extra unneeded testing. Cervical cancer in women under 21 is extremely rare and almost all of these women will get rid of their HPV infection within 1-2 years. We do still recommend that all sexually active women have a yearly annual exam even if they are under age 21. This gives us the opportunity to talk about birth control options, safe sex practices and screen for sexually transmitted diseases.
Women age 21-29 are advised to have pap smears every 2 years. In this still young population we do not routinely test for HPV either because there is a strong likelihood these women will have transient HPV infections that are eradicated by their own immune system. If their pap smears come back mildly abnormal they may be tested for HPV to help decide if further testing is necessary. We do still recommend yearly annual exams though to discuss annual well woman issues like birth control, safe sex, STD testing, breast cancer screening etc.
For women age 30-65, if you’ve had 3 consecutive negative pap smears, the ACOG is recommending Pap smears every 3 years. Because HPV is a sexually transmitted virus, any new sexual partner could expose you to new strains of HPV and women in this age group with new sexual partners should discuss their pap testing with their physician. Yearly annual exams are still recommended to discuss well woman topics like family planning, sexual function and eventually menopause. They are also important because during the annual exam we perform breast and pelvic exams which screen for breast cancer and other forms of gynecologic diseases and help you stay on top of your other preventative health care tests like mammograms, colonoscopies, and bone density scans.
After age 65, the most recent guidelines are a little more controversial. The ACOG recommends that either at 65 or 70 years of age, women who have had 3 or more negative pap smears in a row and no abnormal tests in the past 10 years, can discontinue cervical cancer screening. The American Cancer Society recommends discontinuing at age 70. I recommend discussing this with your physician because it should be a decision made about your specific situation. Even after you and your doctor decide to stop performing pap smears, we still recommend yearly breast and pelvic exams. Check with your insurance provider about coverage. These exams can be done by your internist or family doctor, or by a gynecologist.
Keep your eyes open for further changes in cervical cancer screening. As we develop more testing and technology about HPV, it’s possible that pap smears may be less necessary and we may be changing to focusing more on HPV testing. Trials are currently underway looking at more accurate alternatives for cervical cancer screening. Until then, continue staying up to date with your pap smears with the guidelines outlined above.