The Pap Test: Finally a Consensus on Cervical Cancer Screening

Everyday Health  April 30, 2015

Everyday Health  April 30, 2015

If you have had the experience of your internist telling you only need a Pap every three years, your gynecologist telling you every two years, your hairdresser telling you every five years, and you end up getting a Pap every year because you are confused and just don’t want to get cancer, you are not alone.

The ritual of the annual Pap test has pretty much gone the way of the dial phone as the result of new screening technology and HPV (human papillomavirus) testing. It is clear that low-risk women do not benefit from yearly screening, and, in fact, some women need not be screened at all.

The problem is, there have been so many different recommendations from different organizations, it is not unusual for women to get conflicting recommendations from different doctors, websites, and magazines, leaving women to try and figure out which test is best, and how often to get it.

In a valiant effort to bring consistency to cervical cancer screening, the internists (American College of Physicians), gynecologists (American Congress of Obstetricians and Gynecologists), The American Cancer Society, and other key organizations have finally agreed on the following guidelines:

Cervical Cancer Screening Guidelines

Age to begin screening: 21 years

Screening method and interval:

  • Age 21 to 65 years: cytology every three years

Or

  • Age 21 to 29 years: cytology every three years
  • Age 30 to 65 years: cytology plus HPV testing (for high-risk or cancer-causing HPV types) every five years

Age to end screening: 65 years, assuming three consecutive negative results on cytology, or two consecutive negative results on cytology plus HPV testing within 10 years before cessation of screening, with the most recent test performed within five years.

Screening after hysterectomy with removal of the cervix: Not recommended.

(Note that these guidelines are for average-risk women who have no history of high-grade, precancerous cervical lesion or cervical cancer; are not immunocompromised, not infected with HIV, and had no in utero exposure to diethylstilbestrol (DES).)

So, hallelujah, finally everyone is in agreement that too-frequent or unnecessary screening leads to extra expense and painful unnecessary colposcopies and biopsies. Everyone agrees that women under the age of 21, and low risk women over 65 do not benefit from routine cervical cancer screening. Everyone agrees that adherence to these new guidelines will not result in more women ending up with an invasive cervical cancer.

Why You Still Need Your Annual Gynecologic Exam

But here is what everyone does not agree on:

The American College of Physicians feels that in a non-Pap year, there is no reason for a woman to have a gynecologic exam unless she has a specific complaint.

As a gynecologist, I feel very strongly that even if a woman does not need a Pap test, there is a great deal of benefit from an annual gynecologic exam.

No complaint does NOT translate to “no problem,” and the majority of conditions I diagnose and treat have NOTHING to do with a Pap test. This is particularly true for the midlife-or-beyond woman.

Incontinence, vaginal dryness, pelvic organ prolapse, sexual problems, or new growths on the vulva or cervix are among the very long list of conditions and issues that I address at an annual visit even if my patient does not voice a specific concern, either out of embarrassment or the belief that her problem is just a “normal” consequence of aging.

So yes, these new Pap guidelines make sense and will, theoretically at least, lead to less confusion. But yes, you do still need to see your gynecologist even if it is not a “Pap-test year.”

Who else is going to look in your vagina?

PHOTO CREDIT: Alamy