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Ask the Doc

What are the new guidelines for Pap smears?

Dr. Daniel E. Bolet, M.D. | 5/22/2014, 9 a.m.

“I’m here for my yearly Pap smear,” is a phrase commonly heard by gynecologists.

Many women are under the impression that a Pap smear test – a screening for cervical cancer done during a pelvic exam – is an annual medical necessity. That was the case in the past, but not today.

Since the 1940s, Pap smears – named after Dr. George Papanicolaou, the developer of the technique – have been the gold standard in cervical cancer screening techniques. After cells are collected from the

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Dr. Daniel E. Bolet, M.D.

cervix, the test is used as a tool to identify abnormal and potentially malignant cells. The Pap smear is a quick, inexpensive, and easily reproducible way of knowing if a patient is “at risk” of cancer by identifying abnormal cells through the Pap smear.

The cause of most types of cervical cancer is the Human Papilloma Virus, more commonly known as HPV, a sexually transmitted viral infection that is extremely common and can affect both men and women. There are many types of this virus, and the immune system usually clears it on its own. However, a persistent infection with certain types of this virus is what causes virtually all cases of cervical cancer.

The yearly Pap smear is no longer necessary as doctors now combine two tests to determine the risk factors. Gynecologists now employ a combination of both the Pap smear and testing for HPV to guide their decision-making in regards to screening for cervical cancer. By combining those two tests and understanding how the virus works, it makes it reasonable to wait a longer interval between Pap smears. This, of course, varies by age and different conditions.

It is important to understand that preventing 100 percent of cervical cancer is unrealistic, and a screening test that is 100 percent effective does not exist. This means that unusually rapid growing cervical cancers – like the rare cases found in teens and very young women – cannot be reasonably prevented by any amount of screening.

The guidelines for performing Pap smears change frequently, so gynecologists need to keep up-to-date with the newest recommendations to make sure their patients are receiving the best possible care.

The most recent changes – recommendations by the American College of Obstetricians and Gynecologists in 2013 – advise that a “yearly Pap” is no longer the standard of care. Here are some general recommendations:

• A woman’s first Pap smear should be done at age 21; this includes women who are sexually active at a younger age.

• Women between the ages of 21 and 29 should have a Pap smear once every three years.

• Women between the ages of 30 to 65 should be “co-tested” with both the Pap smear and HPV testing once every five years. A Pap smear done on its own once every three years is acceptable, but not preferred.

• Women over 65 who have had normal prior screenings and are not at high risk for cervical cancer no longer need Pap smears, if they meet certain conditions. Women in this age group must discuss this with their doctor prior to stopping the screenings.

If you have certain conditions, these guidelines may not apply to you. Regardless of your age, it is important that you discuss these guidelines with your doctor. Always remember that it is best to follow the advice from a doctor who knows your medical history.

Even though a Pap smear may not be recommended annually, an annual, routine visit to the gynecologist is still recommended for all women. These visits are a great time to take care of other concerns surrounding women’s health – everything from breast lumps to sexually transmitted diseases to childbearing issues.

Daniel E. Bolet, M.D., is a medical director of the Jackson Medical Group’s obstetrics and gynecology practice. His medical interests include gynecological and minimally invasive surgeries, and general obstetric care. To make an appointment with Dr. Bolet, call 305-585-4JMG.