Wellness & Education

Wellness & Education

Pap Test Frequency: When Less is More

Note: this original post was updated in May, 2013 to reflect additional changes to cervical cancer screening guidelines.

A Pap test or smear, named for the physician who discovered it in the 1940s (Pap is short for Papanikolaou), is used to help identify changes in the cervix that might lead to cervical cancer. Most women are very familiar with the Pap test – it has been a standard part of a woman’s annual exam for decades. Your provider collects the cells for a Pap test using a speculum to see the cervix and a brush or other tool to collect the cells.

Portland, Oregon - gynecology, Pap test, cervical cancer screeningThere have been recent changes to recommendations about Pap testing frequency. The new guidelines are as follows: 

  • Pap testing should begin at age 21. 
  • Women between age 21 and 65 should be tested every three years. 
  • Most women without a history of serious abnormalities can quit testing after age 65.

Pap smears continue to be very effective in helping to diagnose pre-cancer and preventing the progression to invasive cancer. However, we have learned that virtually all abnormal Pap smears are related to Human Papilloma Virus (HPV). The immune system will clear most HPV infections over time, but this can take up to two to three years. Most women who receive abnormal Pap results related to HPV will have normal results when the infection clears.

We also know that more frequent testing can lead to more treatment. This is especially true in younger patients where HPV infections are common. Treatments for abnormal Pap results can include procedures such as LEEP (“Loop Electrosurgical Excision Procedure,” where a thin wire with an electrical current is used to remove abnormal tissue), cryotherapy (where the abnormal tissue is frozen off), or conization (where the abnormal tissue is cut away). These treatments can increase the risk of future pregnancy complications by weakening the cervix.

Unlike most other cancers, the risk of cervical cancer decreases in older women with normal Pap test histories. The new HPV vaccines can help prevent the majority of serious pap abnormalities. Smoking increases the likelihood of persistent HPV infections and should be avoided. The use of condoms may help prevent HPV transmission.

Even though new recommendations indicate waiting until age 21 to begin Pap testing, we recommend annual screening for sexually transmitted infections, such as Chlamydia, beginning with the onset of sexual activity (read more about the importance of establishing gynecological care for teens). Although the need for yearly Pap testing has changed, most health care providers believe there is a benefit to an annual preventive health assessment. Discuss this with your health care provider.

It is important to remember that the recommendations for Pap smear frequency are just guidelines. You and your provider should discuss the appropriate frequency for you based on your medical history and risk.

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Anton Broms, MD - OB/GYN Physician and Surgeon, Tualatin, OregonDr. Anton Broms is a board-certified OB/GYN physician and surgeon who sees patients at the Tualatin, Oregon office of Women’s Healthcare Associates, LLC. He attended Stanford University and completed his medical degree and OB/GYN residency at Baylor College of Medicine. He enjoys all aspects of the obstetrics and gynecology field--including delivering babies at all hours of the day and night. His passion is educating women to be informed partners in their care and to fully participate in the decision-making process.