Pap Test Guidelines – Less Truly is More

kansasIn recent months we have had a slew of questions about the new pap test guidelines from patients and colleagues. Recent changes have left many women confused about an age-old yearly test. So we want to debunk some of the myths, and clear up some of the confusion.

Screening for cervical disease and prevention of cervical cancer has been one of the biggest advances of the modern era. The introduction of the “pap smear”, now called the pap test, has resulted in far fewer cervical cancer cases and deaths.

Unfortunately, it has also led to significant patient anxiety over:

  • Abnormal pap results
  • Numerous followup tests and procedures
  • Possible effects of these procedures on future reproductive health.

As with most procedures, major scientific advancements have been made over the past few decades resulting in better screening tools. So here is where we stand in 2013…

We know that HPV, human papilloma virus, and specifically certain strains of HPV are the causative agent for nearly all cervical cancers. We also know that most women will get HPV over the course of their lifetime through sexual contact. Luckily, most of these women will clear the virus through their own immune system.

A small subset will not clear the virus and those women are at risk for the development of cervical cancer and pre-cancer. But it takes a long time for cervical disease to develop once HPV infection occurs. With this knowledge and the ability to test easily for various strains of HPV, the pap test has been supercharged, so to speak, to give us better predictive information and identify at risk patients.

Some key points in the new guidelines are that women under age 21 do not need pap tests. HPV infections are common and usually transient in this age group; they do not pose significant risk. Women between age 21 and 29 need pap tests less frequently than yearly if they are normal. Women over 30 benefit from the addition of testing for high risk HPV strains to their pap test. In fact, those who have a normal pap test and are not carriers of HPV need the test only every 5 years. Those who are carriers of HPV should be followed more closely. Women with hysterectomy and removal of the cervix as well as those over age 65 do not need pap tests anymore.

Well, ladies…I can already hear the sighs of relief as you think to yourself, “Now I don’t need to go to the gyno. Awesome!” Don’t get ahead of yourself.

There is much more than just cervical cancer screening going on at that yearly visit! Remember, we are also evaluating you for problems regarding:

  • Breasts
  • Vulvovaginal anomalies
  • Uterine and ovarian problems,
  • Colon disease in some women.
  • Reproductive health
  • Menstrual problems
  • Contraception
  • STI prevention
  • General health maintenance
  • Disease prevention

So it is still recommended that you come in for your “annual exam” each year, even if you do not need a “annual pap test.” As always, screening test recommendations vary based on each patient’s age, specific history and risk factors, so talk to us at your next annual examination and we can guide you how these new recommendations affect you.

As always, if you have specific questions, you can also contact our office at anytime– (757) 425-1600.

-Reena Talreja-Pelaez, M.D.