When women come in for their yearly well-woman exam, many are surprised to find out that they may not need a pap smear. This is because the mechanisms through which women develop changes in their cervix that may lead to cervical cancer are now much better understood. This had led to a drastic change in pap smear screening recommendations with the most recent updates to recommendations in 2012. Although, we still recommend regular well-woman exams, it is likely that most women will only need a pap smear every three to five years.
What causes cervical cancer?
- The simple answer is the human papilloma virus (HPV).
- Human papilloma virus actually refers to a family of viruses: some high risk and some low risk.
- The low risk types can cause genital warts, but are “low risk” for causing cervical cancer.
- The high risk types are “high risk” because they may cause cervical cancer in some patients.
- At least 80% of all sexually active women have been exposed to the HPV virus during their lifetime and that is why we recommend screening for everyone.
What exactly is a pap smear and what does it test for?
- A pap smear is a screening test that tests for cervical cancer or precancerous changes on your cervix.
- We obtain the sample by performing a pelvic exam and collecting cells from the cervix using a small spatula and brush.
- In women over the age of 30 we also test for high risk types of human papilloma virus (HPV) in conjunction with your pap smear.
- In women younger than the age of 30 we do not test for HPV since women in this age group will often test positive but the infections are generally temporary.
Who should get pap smears?
- We recommend that you get your first pap spear at 21 years old, regardless of when you have your first sexual encounter.
- Women who are over the age of 65 and have had at least 2-3 normal pap smears over the preceding 10 years (the most recent within the past 5 years) may stop getting pap smears.
- Women who have had a “total” hysterectomy (meaning their cervix was removed with the uterus) may stop getting pap smears as long as they were never diagnosed with cervical precancer or cancer prior to their surgery.
- Women on their menstrual cycle may still get a pap smear since new technologies allow for adequate sampling despite the presence of red blood cells.
How often should I get a pap smear?
- Your provider may determine that you need increased screening based on your history, but for most women with a history of normal pap smears:
- < 30 years old, every 3 years
- >30 years old, every 5 years