“What do you mean no pap today?”–dealing with changes to cervical cancer screening

Let’s talk a little bit about cervical cancer screening.

I’m a family doctor, so all day long I talk about preventive care–updating patients’ pap smears, mammograms, and colonoscopies. Physical exams or annual exams, are vitally important still, particularly for finding the “silent killers”. Silent killers are things we don’t know we have until we get checked out. Pap smears are how we screen for cervical cancer, which is a devastating disease. I call myself the “pap queen,” since I can do them with my eyes closed, essentially. I do them daily in practice, for good reason. However, with recent changes in recommendations, we should not do them as often.

I often have the discussion with my patients and ask, “when was your last pap smear?” As of March 2012, the official guidelines from American College of OBGYN (ACOG) include that #1- no pap smears should be done until age 21, even if you are sexually active. For some, that’s been a hard pill to swallow. Side bar–It’s all about your comfort level. If you want a pap or any screening test, for that matter, you are allowed to be an advocate for yourself. That is, of course, unless it causes you harm. We can do STD (sexually transmitted disease) testing without a pap. Random urine testing is actually more accurate than a swab for Chlamydia and Gonorrhea. Blood work and swab testing are the ways we test for Hepatitis B, Hepatitis C and HIV. The virus that causes cervical cancer, HPV (Human Papilloma Virus) is transmitted sexually, but it can take a couple of years for it to show up.

It’s very common for women to have a slightly abnormal pap smear, at least once in their lifetime, and it might be or might not be HPV related. It causes concern, and rightfully so, but it doesn’t always mean cancer. As women, hormonal changes are almost always going on, which can often be the cause of an abnormal pap, as well.

Another change that the guidelines expressed was from age 21- 65, after a normal pap smear, paps should be done no more than every 3 years. The overwhelming thought is that we are doing too many of them, too frequently, and too soon, which actually puts patients at more risk of harm than good. By doing too many tests, false positives happen. We aren’t giving women long enough time for their body to change especially after hormonal changes, breast-feeding, giving birth, etc.

The last big change is that at the age 30, you can decide to have your pap smears every 5 years as long as you are getting testing for STDs regularly and have a negative HPV results. If there is a history of abnormal pap smears or a history of cervical cancer, then you may need to get your pap smears more frequently. There is no recommended screening test for ovarian cancer yet, but pelvic ultra sounds are being considered. CA125 blood tests can be done to follow people who have had ovarian cancer, but are not considered good screening tests as of yet. For ovarian cancer, I do a manual (by hand) exam and feel for masses and tumors. Prevention of cervical cancer and HPV include no sexual activity, no smoking and getting your regular check ups and pap smears. It’s also very important to know your family history. Go get your check ups and have a speculum exam, if needed, but the actual test of doing a pap smear does not have to be done always.

2 responses to ““What do you mean no pap today?”–dealing with changes to cervical cancer screening”

  1. Thank you for the information.

    Call me old school but I just can’t get behind waiting 5 years for a pap. What is something /some type of cancer starts developing.

    I am so afraid of Cancer in every form that I want to take all precautions as often as I can.

    I am going to have to really think about this one.

    Thanks for the information!

    1. Hi! Thanks for reading and following. I hear you. I don’t know if I’m ready to wait 5 years either, personally. The good news is you, as your own health advocate, can decide when you want to have one. You have the power!

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