Dr. Jacqueline Gerhart: What You Need To Know About Pap Smear Guidelines
Madison, Wisconsin - UW Health Family Medicine physician Jacqueline Gerhart writes a column that appears Tuesdays on madison.com and in the Wisconsin State Journal. Columns are re-published here with permission.
Every once in a while new guidelines come out that change the way we practice medicine. On March 14, women across America rejoiced: The frequency of Pap smears (for screening for cervical cancer) was reduced.
Now, women age 30 to 65 only need a Pap test every three years. And if they get an HPV test with their Pap — which is called "cotesting" — they can extend that interval to every five years.
HPV is human papilloma virus, which is the main cause of cervical cancer. So the guidelines noted that if a woman is negative for HPV, her chances are nearly zero for getting cervical cancer in the next five years.
These recommendations have been agreed upon by the American Cancer Society, the American Society of Colposcopy and Cervical Pathology, the American Society for Clinical Pathology and the United States Preventive Services Task Force. In other words, four prominent expert organizations all agree — pretty amazing.
These are considered "consensus guidelines," meaning the experts in the field review all available evidence and conclude how we should apply this to our patients. In essence it is a "risk-benefit" analysis. They want to find a happy medium between testing too infrequently that people develop cervical cancer and testing too frequently, resulting in more surgery and more worry for no benefit.
Before 2006, many women were still getting Pap smears on a yearly basis — even if they were always normal. However, we found that extending that interval was possible without significantly increasing a woman's risk of getting cancer, since the virus that causes cervical cancer, HPV, takes 10 to 25 years to develop into precancer or cancer.
Plus, if a women has an abnormal Pap, the new guidelines will follow her more closely — often with Paps every six to 12 months. At this point she is no longer in the "screening" category. This is similar to colonoscopies — if they don't find anything, you can usually wait 10 years until your next one. However, if they find polyps or other changes, you are often asked to come back in three to five years.
Let me answer some questions:
Q: I'm 19, do I need a Pap?
A: No. Regardless of if you are sexually active, have multiple partners, or have been vaccinated for HPV, you do not need a Pap smear. You still should see your primary-care provider on a yearly basis for immunizations, screening for sexually transmitted infections and to discuss birth control. But you won't get a Pap smear until age 21. The new guidelines state that women aged 21-30 with normal Pap smears, need them every three years.
Q: I'm 31 and my Pap was normal. How do I know if I can wait five years until my next Pap?
A: Many providers now do "cotesting," which means with your Pap smear, they also test for HPV. If your HPV status also is negative, your provider will likely recommend can wait five years.
Q: I had an abnormal Pap five years ago. Can I be part of the new "Pap and HPV testing every five years" program?
A: It depends. If you had a procedure due to precancer or cancer, then you likely will need to be followed more avidly. If you never had a surgery or procedure, then you may be eligible for the five-year plan. Also, this plan doesn't apply for women with HIV or who are otherwise at high risk for cervical cancer based on prior testing.
The new guidelines were published in the Annals of Internal Medicine, www.annals.org. Talk to your provider to see how these guidelines apply to you.
This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Gerhart to people submitting questions.
Date Published: 03/20/2012