PAP Smear and Pelvic Exam
The Importance of a Yearly Pap Smear
Pap smears can detect abnormalities before they turn into cancer.
By Alyson McNutt English
Medically Reviewed by Lindsey Marcellin, MD, MPH
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Regular preventive care is one of the most important ways to maintain your health over time. If you wait to see a doctor only when you notice a problem, it may be too late.
Cervical cancer screening is especially important for women’s health — but how and when it should be done has been the subject of some recent debate.
Current guidelines from the American Society of Obstetricians and Gynecologists (ACOG) recommend that women should have a Pap smear every two years starting at age 21. After age 30, you may decrease the frequency to every three years if you’ve had three normal Pap test results in a row and if your immune system has not been weakened by a virus or recent health condition.
Other organizations, however, including the American Cancer Society, suggest that women over 30 should be screened using a combination of both the traditional Pap and the HPV (human papillomavirus) test — which, according to a recent study published in the journalLancet Oncology, may detect abnormal cervical lesions earlier and more accurately than the Pap test alone.
More research is needed to determine how the HPV test should be incorporated into our screening program, but experts say it’s not likely to replace the Pap anytime soon. For now, both ACOG and the U.S. Preventive Services Task Force say Pap smears are a woman’s best bet for early detection of cervical cancer.
“Pap smears can detect early precancerous changes on the cervix,” explains Johnathan Lancaster, MD, PhD, chair of the department of women’s oncology and director of the center for women’s oncology at H. Lee Moffitt Cancer Center and Research Institute, in Tampa, Fl. “These changes can be easily treated, thus dramatically reducing the risk of progression to cervical cancer.”
What Problems Can a Pap Smear Detect?
“Pap smears arenotdesigned to detect cervical cancer,” says Dr. Lancaster. “They are designed to detect cervical dysplasia, or precancerous changes [in the cervix].” When abnormal cells are detected by Pap smear, your doctor can take steps to figure out the culprit behind these changes and treat the condition before it turns into cancer.
How Often Should I Have a Pap Smear?
“Like all medical tests, Pap smears are not 100 percent accurate,” he says. “This reinforces the importance of having regular Paps, so that even if one Pap misses an early abnormal change, it’s likely to be picked up at the next Pap.”
What if I Have an Abnormal Pap Smear?
An abnormal Pap smear means abnormal cells have been identified on your cervix. Depending on the type of cells found, your doctor may recommend repeating the test in four to six months, Lancaster says. Other times, they may choose to perform a colposcopy in order to get a better look at the cervix and take tissue samples to biopsy so they can determine what types of cells are present.
During a colposcopy, a thin tube with a very small camera attached to it is gently inserted into the vagina, up to your cervix. During a biopsy, your doctor removes a small piece of tissue from your cervix to analyze it under a microscope. The results of these tests can determine the nature of the problem and guide treatment.
When Should I Start and Stop Getting Yearly Pap Smears?
The American College of Obstetricians and Gynecologists recommends women begin getting Pap smears within three years of the first time they have sexual intercourse, or by age 21, whichever comes first, says Lancaster.
“Some women may discontinue Pap smears after age 65, but this needs to be a highly individualized decision based on risk factors and decided in conjunction with their gynecologist,” Lancaster says.
How Should I Prepare for a Pap Smear?
Lancaster says the presence of any substance in the vagina can lower the accuracy of a Pap smear. He recommends women avoid douching or engaging in sexual intercourse for two to three days prior to having a Pap smear to get more accurate results. Lancaster also says it’s preferable that women not be menstruating when having a Pap smear, since this too can interfere with the accuracy of the test.
What Happens During a Pap Smear?
Pap smears are generally painless and usually done during a pelvic exam. The doctor will position you on the exam table and insert a device called a speculum into your vagina; the speculum opens the vaginal area wider, giving the doctor a better view of the cervical area. The doctor will then swab your cervix with a brush or cotton swab to collect cells from its surface, and then send the cells off for analysis to see if there are any abnormal cells present.
Although Pap smears can seem like an uncomfortable nuisance, they are critical to keeping women of all ages healthy. Talk to your doctor to determine how often you should have a Pap smear.
Video: Pap Test - Dr Thacker
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