Most of us are familiar with the term Pap smear, but let’s pause for a moment to discuss what a Pap is, why we need it, and how often we need it. The Pap smear was introduced in the mid 1940’s by Dr. Papanikolaou as a screening test for cervical cancer. It’s the swab business. The purpose of the Pap is to give us information about abnormal or pre-cancer cells of the cervix. It can’t tell us about the ovaries or really much of anything else about the genital tract. Cervical cancer is most common among women in their 40’s who smoke, are immunocompromised, are not going to the doctor for screening visits, and have had multiple sexual partners (which is a point of exposure to HPV—the high risk viruses that cause over 90% of all cervical cancers). About 14,000 new cases of cervical cancer are diagnosed in the US each year, which is a dramatic reduction (just over 50% reduction) since the 1970’s. The goal is to capture pre-cancer abnormalities of the cervix with the Pap smear screening to then be able to take measures to prevent progression to cervical cancer.
With respect to frequency for Pap smear screening guidelines, for many, many years the Pap smear alone was recommended annually. Just looking at the cells from the cervix under the microscope isn’t super accurate—only about as accurate as a coin toss—thus the need for every year testing. Then in 2011, it was recommended that we stop screening young women under age 21 because their robust immune systems will clear the cervical abnormalities most likely within two years from HPV exposure and sexual debut. The HPV test was validated to go along with the Pap smear evaluation of cells under the microscope and recommended for women age 30-65. And now, as of Fall of 2024, the FDA has also approved primary HPV screening without the actual Pap smear for women age 25-65. If normal, screening is recommended every 5 years. Keep in mind, though, that it is NOT recommended to avoid the gynecologist for five years! An annual exam for evaluation of breast and pelvic structures that we don’t have screening tests for like the genital skin, ovaries and uterus is still recommended.
The optimal screening depends on a particular woman’s history and the testing that her gynecologist has available. Most labs in our area have the cytology and the HPV co-testing but the FDA primary HPV screening test approved this past Fall may not be as readily available or covered by major insurance carriers. In general, Paps should begin at age 21 and if normal, happen every 3 years. Then from age 30-65, Pap smears with HPV testing every 5 years may be optimal. Alternatively, HPV screening alone may be done every 5 years, provided they are negative. After age 65, a woman may be “off the hook” for the Pap smear if she has had normal screening for the past 10 years and no prior history of cervical cancer or high risk pre-cancer in the prior 20 years. Women who have had a hysterectomy with removal of the cervix and have had no prior cervical cancer or pre-cancer no longer need Pap smears.
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