When you go to your gynecologist for an annual exam, multiple topics will be discussed, an exam will be performed, and testing may be done based on your age and your concerns. Recommendations are made for preventive health care. Topics to discuss may include your periods, your sexual activity, pregnancy intention screening or need for birth control, your pap smear history, and other general well being information like your exercise routine, and eating habits.
If you are like many of my patients, you may be unaware of cervical cancer screening guidelines and when you need a pap smear.
In the past, women have been screened for cervical cancer with yearly pap smears. This testing has changed.
Our current guidelines recommend the following:
- Ages 21-29: Pap smear once every 3 years
- Ages 30-65: Preferred screening with pap smear and human papillomavirus (HPV) test once every 5 years (if pap smear is normal and pap smears the last 10 years were normal). Alternate screening is pap smear only every 3 years.
The guidelines have changed because studies have shown that there is no overall advantage to yearly pap smears. More follow-up testing and procedures may be performed for women who do not need them and do not actually have cancer.
A pap smear with a test for HPV can help predict if pre-cancerous cervical cells may become present in the next few years, even if the pap smear is normal. HPV is the virus that causes almost all cervical cancer. When your pap smear is normal and the HPV test is negative, the chance that you will develop pre-cancerous cervical cells in the next 4-6 years is very low. Testing for HPV is not recommended for younger women less than 30 because it is a very common virus, and most healthy young women will clear the virus on their own without treatment.
Even though you don’t need a pap smear every year, you should still have an annual gynecologic exam to discuss other issues. The following screening tests and topics may be discussed:
- Clinical breast exam every 1-3 years, importance of breast self awareness
- Screening for sexually transmitted infections (gonorrhea and chlamydia) every year in age < 24 years, and as needed for older patients based on risk factors. Screening for HIV, syphillis, hepatitis can be done as needed.
- Discussion of HPV vaccine (Gardisil) if not completed in women < 27 years old
- Discussion of birth control needs or preconception counseling if planning pregnancy
- Sexual activity and function
- Physical activity, nutrition, cardiovascular risk factors
- Family history, particularly history of female cancers
American Congress of Obstetricians and Gynecologists. New Guidelines for Cervical Cancer Screening, September 2013.
By Loriana Newman, M.D. - Expert Obstetrician/Gynecologist