Keep the yearly exam, lose the yearly pap – the benefit of less frequent pap smears
For generations, women were taught that a yearly pap smear was essential to screen for cervical cancer. For most women, the yearly pap was the cornerstone of preventative health care. In the medical community, the idea of less frequent paps has been discussed over the past several years. In 2012 consensus has been reached for new pap smear screening guidelines. From age 21 to 29, in most women, pap smears should be done every three years. After 30 years old, most women can have a pap smear every three years, or better, a combined pap and HPV test every five years.
I have observed that there is quite a bit of confusion about what a pap smear is. Many women equate the term “pap smear” with any sort of pelvic examination and testing. A pap involves the collection of cells from the cervix, which is the opening of the uterus. The purpose of the pap is to detect cervical cancer as well as early precancerous cells that can turn into cervical cancer. A pap smear will not test for sexually transmitted diseases or other gynecological cancers like uterine or ovarian cancer. It is also not the test of choice if a woman has symptoms of what she thinks might be a vaginal bacterial or yeast infection. If you have symptoms that make you think that you might have a pelvic or vaginal problem, it is wise to come in for an exam to investigate what the issue might be. However, this pelvic exam might not include a pap smear.
If the pap detects cervical cancer and precancer, wouldn’t more frequent screenings be more beneficial? Not in most cases. Since paps cannot distinguish between changes in cervical cells that will lead to cancer from those that will not, overscreening can lead to unnecessary gynecologic procedures. Data has been studied from thousands of women over many decades. It is clear that yearly pap smears do not prevent or detect any more cases of cervical cancer than do pap smears every three years. Furthermore, by waiting three years between pap smears, the body has a greater chance to heal minor changes in the cervix that would go away without treatment. These changes would not have lead to cervical cancer, but would be picked up by the pap smear as abnormal anyway. By reducing the risk of detecting these non threatening changes on the cervix saves unnecessary worry, discomfort, money and time.
It is important to note that these screening guidelines are for women of average risk. If you have had cervical cancer or a high grade cervical dysplasia in the past, or if you are immune deficient, please discuss this at your next appointment. We will recommend a pap smear schedule suitable for your needs. Also, the guidelines outlined above are for screening. If you have symptoms that may indicate cervical cancer, a pap smear might be recommended.
In spite of the yearly pap smear being a thing of the past for most women, the annual exam is still strongly encouraged. It is important to have examinations other than the pap smear on a yearly basis. For example, it is important to be screened for heart conditions, breast cancer, and high blood pressure on an annual basis. The annual exam gives time to check in with your doctor about sexual health and family planning needs, screening for osteoporosis and colorectal cancer, and other health concerns. I can remember quite a few times in my practice as a physician when during the course of an annual exam, I have have picked up a condition that might have been dangerous if left untreated. These patients did not report symptoms of any abnormality. Because of these personal experiences, and because numerous studies recommend it, I am a strong advocate of a yearly check up for all patients. See you at your annual!
Yours in health,
Dr Kahn