This question is one that has been confusing ladies for the past decade.
“Doc, do I need a Pap Smear (or test) every year or not?”
For years, even decades, it was the expected routine health maintenance to have Pap tests every year. Health maintenance was as follows: Pap every year, dental cleaning every six months, oil change every 3000 miles, etcetera and so on.
In 2006, everything changed. Data from over 1 million women was compiled to rewrite the guidelines. The data was collected and analyzed to basically determine how abnormal Pap testing should be treated in order to keep women safe but also decrease overuse of resources. The result was over 20 different algorithm guidelines offering management of all types of abnormal Pap testing at various ages.
“Wait a minute. What is a Pap Smear? What does a Pap even test for?”
Great question. A Pap test is a test that collects a sample of the cells located on your cervix. It looks specifically for cells that are changing into cancer and sometimes for the HPV virus. A Pap does NOT check for sexually transmitted infections like gonorrhea, chlamydia, herpes, HIV, etc. Also, even though a Pap is performed using a speculum (that “duck lip” contraption)every speculum exam IS NOT a Pap. I can’t tell you how many times I have heard a woman say these words:
“Oh, they did a Pap smear when I was in the ER.”
No, they didn’t, ma’am. Emergency room physicians don’t do routine health maintenance tests like Pap tests. They check for bleeding and infection with speculums, not precancerous changed on the cervix.
Back to the guideline changes, the summary point was that Pap testing is not necessary for many women every year. BUT WHY? Well, some of my patients have proposed that it is solely to cut costs in the healthcare field. That’s not the main reason though.
Then why do we NOT need Pap tests every year?
There are two main reasons why Pap tests don’t need to be done yearly for some.
- Cervical pre-cancerous cells become abnormal VERY slowly.
- HPV is a known cause of abnormal cervical cells, so if we can determine it’s presence, we can know our level of risk. Said differently, if HPV isn’t detected, we are pretty safe for a while.
I like to think of the Pap test as surveillance against burglary. A looped camera system that goes from one area of a property to another, and does so at a rate of speed that would hopefully catch an intruder before they cause too much trouble. If there is no intruder and all of the doors are locked, we can feel pretty secure for a while. If there is an intruder, then we have to zoom in and look more closely and try to eliminate the intruder before anyone is hurt or anything is stolen.
Likewise, cervical cells generally become abnormal VERY slowly. This means that it can take between 2, 3, and sometimes 5 years for a Pap test to become abnormal. Even abnormalities discovered in that time frame should be mild enough for the less frequent Pap to catch before they become dangerous.
“So what do I do if I WANT a Pap every year?”
If I’m your doctor, then you just ask. I always tell my patients who have a history of normal Pap tests that they DO NOT need a Pap every year, but if they want one, insurance still covers it (at least for the most part these days.) It’s hard to change people’s habits. If a lady wants a Pap, I’ll give her a yearly Pap. The one downside to testing every year is that some Pap tests will be slightly abnormal one year, but then go back to normal the next year. We could end up doing follow up testing for something that would have been a non-issue in a year.
“What if I have an abnormal Pap Smear?”
Click here to read a great post that a wrote a little while back about abnormal Pap tests. It explains what an abnormal Pap test means and the management. The post is called What’s Pap-pening. Get it?
I hope that you’ve learned a lot in this post. The take-home message is that if you have a history of NORMAL Pap tests, you may not need to have a Pap smear every year. It is important to know that Pap smear guidelines are exactly that: GUIDELINES. They are meant to guide our management. They are not laws. It is okay to deviate and individualize testing depending on the needs and understanding of an individual person.