“Recently, some new guidelines have been issued about Pap smears and how often you should have them based on age and risk factors,” says Allison Ward, M.D., an obstetrician and gynecologist at Piedmont. “There’s a little bit of controversy with them; the agreement across numerous organizations is that Pap smears should start at age 21.”
A Pap smear is a medical test that examines the cells of a woman’s cervix to see if they are healthy. The Pap smear emerged as the result of the studies of Dr. George Papanicolaou in the 1930s.
“Over-treating in adolescents and late teens can really increase risks with pregnancy in terms of damaging the cervix,” she explains. “Since most abnormalities just go away, we now recommend starting Pap smear screening at age 21.”
Changes in screening guidelines
“The rationale behind having Pap smears less often is that most of these abnormal changes take quite a bit of time to develop - more than two or three years,” says Dr. Ward. “So if you’ve had a normal Pap smear, your chances of developing cancer within three years is very low. However, you might still develop precancerous cells over time that would be detected at your next screening.”
Pap tests can detect the earliest signs of cervical cancer, the fifth most common cancer worldwide and the eighth most common cancer in American women. Your chances of developing cervical cancer peak in your 30s and again in your 50s. In general, you do not need a Pap smear as often if you are not in those peak age ranges for developing cervical cancer.
“But just like we don’t do mammograms until you’re 40 or 50, depending on which recommendation you want to go by, we don’t have to screen as often in younger patients because they are less likely to have a severe precancerous lesion,” Dr. Ward explains.
HPV and cervical cancer
“HPV [human papillomavirus], which causes cervical cancer in women, is asymptomatic, meaning there are no symptoms,” she says. “HPV does have different strains that cause genital warts.”
The vaccine Gardasil protects against the two strains of HPV that cause 70 percent of all cervical cancers.
“It protects against the low-risk strain that causes genital warts as well as the high-risk strain that causes pre-cancerous cells and cancer in the cervix,” says Dr. Ward.
HPV is extremely common: Approximately eight in 10 women will become infected with HPV in their lifetimes. Dr. Ward says she often receives the question, “I have HPV: when did I get it?”
She says there is no way of knowing for sure when a woman contracted the virus.
“If you had a normal Pap smear last year and have an abnormal result this year, it could have been a falsely normal Pap smear in the past,” she says. “Women assume it implies some sort of infidelity by their partner, but it most certainly does not.”
Pap tests and annual well-woman exams
Dr. Ward also has a few key facts patients need to remember regarding Pap tests.
“The first thing I want people to understand is a Pap smear is not a pelvic exam and you still need to see a gynecologist, probably on an annual basis, even though you don’t need a yearly Pap smear,” she says. “That should be a decision made between each patient and her physician about how often she needs a screening based on her risk factors, prior history of abnormal or normal Pap smears, as well as how many sexual partners she has had.”
Continue to see your gynecologist on a regular basis because there are other issues and screenings that need to occur at an annual well-woman exam. Pre-cancerous cells can take 10 to 15 years to develop into cancer, so early detection is crucial.
Routine exams such as Pap tests can greatly reduce your risk of contracting and dying from cervical cancer, so talk with your doctor about how often you need to be screened.
Learn more about cancer prevention and screenings.