Who Really Needs A PAP Smear Anyway

One question we often get ask at the Glasgow clinic is, "Do I really need a pap smear?" So to answer that question I wanted to start with talking about why anybody needs a PAP smear. The purpose as most people know is to screen for cervical cancer. Most cervical caner is related to HPV (Human Papiloma Virus) which is sexually transmitted. This virus causes irritation that leads to cancer so we try to screen to detect it early while it's at a very treatable stage. This leads to three questions:
1) Who needs to be screened?
2) How often do we need to screen?
3) When can we stop?
Today I am not going to address what an abnormal PAP means as this varies quite a bit and should always be discussed in the office with your doctor on a case by case basis.

To answer the first question, who needs to be screened. There are three different professional organizations who weight in on this topic including the American Cancer Society (ACS), the American College of Obstetrics and Gynecology (ACOG), and the US Preventative Services Task Force (USPSTF). All three recommend that we start PAP smear screenings three years after the onset of sexual activity or at the age of at the age of 21, whichever is first.

When it comes to how often women need screened the answer is a little more complex. For most women the answer is every year until you have had three negative PAPs and then every two to three years after that. For women at high risk screening may need to be more frequent. High risk means usually includes having multiple sexual partners or having a history of positive PAPs in the past.

The third question that women want to know is when can I stop getting these tests. The answer is not very well defined. The three above mentioned organizations all pose slightly different opinions. In general they say that women who meet all three criteria below NEVER need to be tested again.
1) Age 65-70
2) Have had at least three negative PAPs in the last 10 years.
3) Are not at high risk.
For this purpose not at high risk means sexually active only within a long term mutually monogamous relationship without a history of cervical or related cancers. We can also stop all PAP smears for women who have had a complete hysterectomy who do not have a history of cervical or uterine cancer.

The final word that I would like to add is the new vaccine Gardasil. This is a vaccine created to prevent HPV infection. It is available for women and girls ages nine to 26. It is a series of three shots that prevent the most common types of HPV and therefor prevent the majority of cervical cancer. It does not prevent all cervical cancer. This is heavily recommended for girls age 13-16 because to be most effective girls need to receive the vaccine before sexual activity. Currently most insurance companies in our area cover this vaccine and it is available through the Glasgow clinic so feel free to ask about it. More information about this vaccine is available at www.gardasil.com.

As always if you have any questions about any of the above material pleas schedule a visit with us at the Glasgow Clinic and we will be happy to discuss these things with you.