Cervical cancer screening is an important part of the annual exam for women. The pap smear has successfully reduced mortality from cervical cancer since its introduction in the middle of the 20th century. Nearly 100 percent of cervical cancer specimens test positive for a virus called human papillomavirus (HPV), suggesting that this virus is the true cause of this cancer in women. Recently, screening for cervical cancer has improved significantly with the addition of HPV testing to pap smears for those older than age 30.
Q: Who should be screened?
A: All females over the age of 21 should be screened with the pap smear. This should happen at least every three years in those up to age 29. After age 30, the HPV screening can be added to the pap. If this is done, and results are normal, the interval between paps can extend up to five years. Screening, however, is an individual decision and should be discussed with your doctor. Some individuals may need closer screening, like those who are HIV positive, immunosuppressed due to organ transplant, or those who are in follow-up for previous abnormal pap smears.
Q: Am I at increased risk for cervical cancer if I have a family history?
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A: No! Because it is thought that most, if not all, cervical cancers are caused by HPV, your family history does not increase your risk. HPV is a sexually transmitted virus. It is thought that most sexually active people have been exposed to HPV at some point in their lifetimes. In most people, this is a transient infection that your body can clear. In some individuals the virus causes changes in the cells of the cervix over time that can lead to cancer.
Q: Why don’t we start pap smears until age 21?
A: HPV prevalence peaks a few years after the median age of first intercourse. In the United States, this is 17 years of age. Most HPV infections are transient and will become undetectable within one to two years. Cellular changes that occur during this point are likely to clear on their own. Only persistent infections are at risk for persisting into cancers. This takes many years on average to occur thus screening is started at age 21. Screening that occurs earlier to this is likely to lead to unnecessary procedures and side effects in patients who would have likely cleared the virus on their own without intervention.
Q: What if I’ve had a hysterectomy?
A: It depends on why the hysterectomy was done and if the cervix was left. If the cervix was left, it is recommended to continue with normal screening. If the cervix was removed and you do not have issues with abnormal paps in your past, then you may be able to stop pap smears. For women who have a history of a high-grade abnormal pap, it is recommended to continue screening for 20 years past the last abnormal.
Q: Is a speculum exam the same thing as a pap smear?
A: No. A speculum exam is an exam where a medical device is placed inside the vagina to allow visualization of the lining of the vagina and the cervix. The pap smear is a specific screening test that can be, but is not always, done during a speculum exam. Speculum exams can be done for many other reasons. Examples include to evaluate abnormal bleeding, to screen for sexually transmitted diseases or to evaluate pelvic pain. Most speculum exams DO NOT include a pap smear. Pap smears are usually done in an OB/GYN or primary care doctor’s office at the time of the annual exam.
Q: If the guidelines state that I don’t need a pap smear every year, do I still need to see my doctor?
A: Absolutely! It is recommended that a woman see her gynecologist at least once a year. The pap smear is only a very small portion of the annual exam. Annual exams also consist of a breast exam and a pelvic exam. They give your provider the opportunity to order a mammogram if warranted based on your age and allow your provider to screen for other abnormalities like colon cancer, pelvic masses or other kinds of cancer. They also offer a great opportunity for you to discuss things like birth control, period issues and family planning with your provider.