Sunday, November 7

Pap Smear Recommendations


Pap Smear Recommendations
New Pap smear recommendations: Update on when and how often women should have Pap smears to screen for cervical cancer.

As you probably heard, the American College of Obstetricians and Gynecologists (ACOG) just came out with new Pap smear guidelines. The latest ACOG recommendations, which appeared several months after my blog on the topic, mark a further departure from the conventional wisdom that every woman should have a Pap smear every year. If you were still getting used to the idea of a Pap smear every two years - the recommendation when I wrote the blog - news that you can wait three years between Pap smears could make you wonder what's going on.

Happily, what's going on is progress. In the 1970s, cervical cancer rates went down by 70 percent because of Pap smear screening. Because of this simple screening test, we were able to prevent almost all abnormal Pap smears from becoming cervical cancer. Since then, we have learned a great deal more about Pap smears and cervical cancer. After analyzing the most recent findings in this area, the American College of Obstetricians and Gynecologists (ACOG) published new recommendations..

Here's a quick summary:

Women should have their first screening Pap smear at age 21. Women in their 20's should have a Pap smear every two years.Women age 30 and older who have had three normal Pap smears in a row should have a Pap smear every three years. Women who have had a hysterectomy should no longer have Pap smears if the hysterectomy was for non-cancerous reasons and they don't have a history of severely abnormal Pap smears. If you have had a hysterectomy but still have your cervix, you will need to continue routine Pap smears.

Pap smear screening can be stopped in women 65-70 years old and above who have had three or more normal Pap smears in a row. These guidelines should be followed whether you have or have not had the vaccine.

My next blog will tell you more about why ACOG made these changes and what they mean to you.
(Following is my original post, which reflects Pap smear guidelines before ACOG published revised recommendations.)

Pap smears: How often?

The Pap smear screening test is one of modern medicine's greatest successes. In areas of the world where it's available, the Pap smear has reduced cervical cancer rates dramatically by detecting infection with human papilloma virus (HPV) and associated changes in cervical cells.

The tradition has been to do a Pap smear annually on all women. Now we are learning that we can decrease the frequency of Pap smears and still protect women.

For example, if you have never had an abnormal Pap smear and you have been with the same partner for a long time, your partner probably doesn't have HPV, so an annual Pap smear is not necessary.
The following questions and answers cover additional recent refinements in Pap smear recommendations.

When should a young woman start having Pap smears?

The recommendation is to have your first Pap smear test three years after you become sexually active or at age 21, whichever comes first. The prevalence of HPV is particularly high in young women soon after they start sexual activity. The good news, though, is that younger women have extremely low rates of invasive cervical cancer, so they usually don't need aggressive treatment for HPV infection.

After I start to have Pap smears, how often do I need them?

From the time you start to have Pap smears until age 30, we recommend a Pap smear every year. If at age 30 you are still in the dating world or have just recently become monogamous (committed to one partner), continue to have a Pap smear every year. Once you have started a long term commitment, you may begin to have a Pap smear every 3 years.

Women age 40 and above still need an annual mammogram, clinical breast examination and pelvic examination. We reduce the frequency of Pap smears, but not visits to a provider.

What if I find myself back in the dating world and I am over 30 years old?

Now you are at risk for HPV again and you should resume annual Pap smears until you are in a committed relationship.

When can I stop Pap smears?

Opinions vary, but most women can stop Pap smears at age 65 or 70 if they've had three consecutive normal Pap smears over the last ten years. But the new-partner rule still applies: Regardless of your age or gynecologic history, a new sex partner puts you at risk again, so you'll need to restart annual Pap smears.

We are all used to getting a Pap smear every year. It can feel uncomfortable to let go of this familiar schedule, but technological progress and accumulated knowledge have made it unnecessary in many circumstances. Talk to your provider each year to assess what your needs are for Pap smear screening.

By Lois McGuire, R.N., M.S.N., W.H.N.P.

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