The New Word on Pap Smears

In November 2009, the American College of Obstetrics and Gynecology changed the recommendations for PAP smears, a revolutionary test that has significantly decreased the risk of cervical cancer in women.

Now, a woman has her first Pap smear at age 21, regardless of when she becomes sexually active. Those 21 to 30 can be screened every two years instead of annually. If age 30 or older with three negative PAP smears in a row, the test can be extended to every three years.

What they didn’t do is equate these new recommendations to how often you should see your doctor. Don’t wait on potential problems or concerns because the annual Pap smear has been extended.

Certain women will need more frequent Pap test screening like those who have HIV, multiple sex partners, previous abnormal Pap test and those with immune system problems. Also don’t let your health insurance guide your access to a Pap smear. The traditional Pap test cost $20-40 and the thin prep PAP cost $45-60. The thin prep test cost a little more because the cells collected for the test are placed in a liquid that gets rid of blood, mucus and debris. These cells are then easier to read for abnormalities. If the test is important, you may need to pay for it. There are also some government sponsored programs that offer free Pap test to qualified women.

HPV (Human Pappillomavirus) is a sexually transmitted virus that increases the risk of an abnormal PAP and certain strains have been related to cervical cancer. This fastidious virus has infiltrated the population, and has become the most common sexually transmitted disease. It affects 20 million Americans, with teens and adolescents at highest risk. HPV affects the mouth, throat and genital areas. It is passed through vaginal or anal sex, but also from oral sex, so be careful of those “friends with benefits” and the belief that oral sex is not really sex. Those infected with HPV can go on to develop genital or anal warts, but more serious, oral anal and as mentioned cervical cancer. Having the HPV vaccine does not change the Pap smear recommendations.

Some feel no PAP is needed if a total hysterectomy (cervix and uterus removed) was done, regardless of age, if it was done for non-cancerous reasons. These include pain, fibroids (leiomyomas) or abnormal bleeding. Cervical cancer screening with PAP smears can also be discontinued at age 65 or 70 if there have been three or more negative PAP smears in a row and no abnormal test results over the past 10 years. If you have had a hysterectomy but still have your cervix, you will need to continue routine Pap smears, as well as those still sexually active (you lucky gals), multiple sexual partners or those with a previous history of pre-cancer changes (dysplasia).

A Pap test can be difficult for some women, especially those who are young, infrequently sexually active or understandably nervous. There are some ways to make it easier. Take an over the counter pain medicine like Tylenol, Aleve or Advil as directed before and after the exam. You can request a small vaginal speculum, a pediatric speculum, a Pederson speculum that is less traumatic, or even a nasal speculum Make this request at the time your appointment is made so they can be made available.

We know that cervical cancer is very slow growing, and in many, the abnormal pre-cancer changes (dysplasia) can be present for many years before a true cancer develops. However, there were 11,270 new cases of cervical cancer in the United States in 2009, and resulted 4,070 deaths. This is still a concerning disease.

Keep up with your PAP smears.