Thursday, May 23, 2013
Posted by: Angela Kondrat, MD
Most of us associate going to the OB/GYN for our yearly exam with getting a Pap smear, which is used to screen for cervical cancer. The test has become routine in the United States, lowering the rate of cervical cancer deaths by more than 50% in the last 30 years. New technology and research have evolved around this screening, and much more is known regarding the causes and progress of cervical cancer. This has led to new and better guidelines for Pap smears and well woman screening exams.
Why the changes?
Human Papilloma Virus (HPV) is the cause of 95% of cervical abnormalities, abnormal pap smears and cervical cancer. There are two classes of HPV: one that causes potentially cancerous changes in the cervix and one that causes genital warts. Most HPV infections are temporary and, when monitored appropriately, resolve without causing any changes to the cervix. The infection (and any cervical changes) will go away in almost all young women without any treatment. Only a small number of infections are persistent, and these can cause the changes that eventually can lead to cancer.
Furthermore, most HPV-related precancerous changes progress very slowly. Even severe precancerous changes take, on average, three to seven years to evolve into cancer. This new knowledge of HPV is one of the main reasons for changes in the recommended frequency of Pap smears throughout a woman’s life.
Women under age 21: no Pap smears
Screening women before age 21 has been shown to be unnecessary and even potentially harmful. While teenage and young adult women have the highest percentage of HPV infection, they also have the lowest risk for cancer. Most HPV infections in this group of women will go away without any treatment. Pap smears, on the other hand, can lead to treatment that could cause injury and increase future pregnancy complications. Our practice follows the American Congress of Obstetricians and Gynecologists’ (ACOG) guidelines of not screening women under 21 with Pap smears. We also encourage vaccination against HPV for those under the age of 26 – including boys and young men.
Women age 21-65: Pap smears every three years
Because we know that cervical changes resulting from HPV take many years to evolve, we now recommend that women age 21-65 have Pap smears every three years.
Women over age 65: no Pap smears
In women over 65 who have not had severe precancerous changes of the cervix or cancer, Pap smears can safely be discontinued.
Do I still need to see my healthcare provider every year?
Even though you may no longer need a Pap smear every year, there are other important benefits to an annual exam. Good preventative healthcare addresses a wide range of issues tailored to a woman’s age, family history and other risk factors. This can include breast exams and mammograms, osteoporosis screening, influenza and/or HPV vaccination, exercise and diet review, general health review, screening for sexually transmitted infections, anemia and other health issues are important topics that your provider may discuss with you. This annual visit is also an opportunity to review your method of contraception and any problems with your menstrual cycle, bladder health and sexual function.
In addition to preventative health measures like maintaining a healthy weight and exercising, your annual exam is an important part of your overall strategy for maintaining optimal health. Schedule yours today by contacting an office.
Dr. Angela Kondrat is an OB/GYN physician and surgeon who sees patients at the Peterkort North office of Women's Healthcare Associates. A native Oregonian, she attended medical school at Ross University in Dominica, West Indies, graduating summa cum laude. Dr. Kondrat returned to the states to complete her residency in OB/GYN at the University of Illinois at Chicago. She enjoys the diversity of obstetrics and gynecology and has particular interest in minimally invasive surgery, vaginal surgery, international medicine and nutrition and wellness.