New Pap Test Guidelines

You need regular check ups: this may not mean a traditional pap smear; we are recommending fewer pelvic exams as well; but no pap doesn’t mean no gyno visit!

If you are not due for the pelvic or the pap, you could access your provider with a video visit or a telehealth visit.

It is possible that your recommendations will change based on whether you have had the HPV vaccine. You can be vaccinated up to age 45.

A revolution in pap smear testing has occurred, women are being told they do not need yearly pap smears based on prior negative pap smears and prior negative HPV testing. Some experts are advising caution. Skipping exams will mean many gynecologic conditions are not being screened for as regularly as in the past. Pelvic exams screen for more than cervical cancer.

Long term studies that were well done still leave gaps in knowledge based on the fact of how many pre-cancers are detected. Cervical cancer takes years to develop and it is not possible to follow women until they do get cancers. The new calculations indicate that there are additional women who will be diagnosed and some will even die during the extra years without a pap smear. You and your gyno can figure out if you are in one of these risk groups.

Cervical cancer detection is more than just a pap smear, it is important to follow up episodes of bleeding or pain, and having a personal gyno to consult regarding how to lower your cancer risks. If you are taking supplements or hormone pellets, this is another reason to get a check up, some of these compounds do have effects on the lining of the uterus.

A pap test is both simple and accurate. Pap smears are a sampling of the cervical cells to determine whether the cells are normal, inflamed, infected, precancerous or cancerous. Based on the look of the cells more testing is indicated before formulating a treatment plan for those that are abnormal. Since pap tests don’t treat cancer, but seek it, as in a simple screening test. Pap smear testing is highly reliable. An overall abnormal rate of pap smears is on the order of 5-8% of all tests.

Many organizations have produced pap smear guidelines, not all are exactly the same. Under age 21 routine pap tests are not indicated, and we may be moving to the first test being done at age 25. The guidelines say that under age 30: Get a regular pap and many add the HPV test ever 3 years, keep getting pelvic exams, and some physicians believe in beginning HPV testing over the age of 25. Over age thirty? Add a HPV test to your pap, or alternatively begin with an HPV test. Over the age of 30 some have even said extend intervals even longer than 3 years to 5 years.

Previous abnormal pap smears, prior infections, lack of knowing what your tests have shown, will change what your gyno recommends for pap test screening. You may have recurrence risk for over 20 years if you have had HPV disease. And you and your gyno know more about your risks, and the absolute costs and potential for harm the test would have in your case. It’s important to keep track of your previous results, to maximize your gynecologic health, avoid infections, do not smoke, use contraception appropriately.

We also suggest using condoms for STD protection, although it is not perfect HPV protection. We know that Gardasil vaccination will affect this as well, but currently whether you have been vaccinated against HPV disease doesn’t change when we recommend pap smear testing.

Very specific factors in your case have to be discussed with your individual gyno, newer FDA approvals mean that women between 26-45 can get the vaccine, but you are more likely to have already had some HPV exposure by age 25.

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Suzanne Trupin, MD, Board Certified Obstetrician and Gynecologist and owner of Women's Health Practice, Hada Cosmetic Medicine, and Hatha Yoga and Fitness

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