When and how often should I get a pap smear?
John W. Martin III, MD, is medical director of the Women's Center at Banner – University Medical Center Phoenix. His office can be reached at (602) 839-4351.
Question: When and how often should I get a pap smear?
Answer: Mounting evidence suggests overutilization of pap smear and human papillomavirus (HPV) DNA testing. Therefore, an advisory panel of separate national societies representing pathologists, cancer specialists, gynecologists and federal preventive health professionals conducted a thorough review of health data, much of which was provided by the American College of Obstetricians and Gynecologists, to establish new recommendations about who should receive pap and/or HPV tests and the frequency of such tests. Following is an overview of the new recommendations to help determine when and what testing is right for you.
- Females younger than 21 should not receive a pap or HPV test, regardless of sexual initiation.
- Women ages 21 to 29 should receive a pap without an HPV test every three years as long as test results remain negative. If pap results report “Atypical Squamous Cells of Unknown Significance” (ASCUS), then follow-up HPV testing should be performed.
- Those between 30 and 65 are encouraged to receive both tests every five years, though a pap alone once every three years is acceptable if results remain negative.
Screening should cease once a woman reaches 66, assuming she has not been treated for moderate dysplasia (abnormal cells on the cervix) or greater in the previous 20 years, and her last two to three screenings were negative. There is no need to resume pap and HPV testing, even if a new sexual partner is introduced.
Regardless of age or the introduction of a new partner, women who had a hysterectomy do not need pap or HPV testing. The only exception is women who had previously been treated for moderate dysplasia or greater.
These guidelines hold true for women who have been vaccinated against HPV. The only exceptions are women considered high risk, including those with a history of cervical cancer, in utero exposure to the drug diethylstilbestrol (DES) that was once used to prevent pregnancy complications, a compromised immune system due to conditions such as HIV, transplant recipients, or those with other high risk suspicions.
While annual pap and HPV testing is not needed, it is imperative that all women receive an annual female wellness exam. This exam, which is independent of pap and HPV testing, is essential to evaluating health of the breasts, vagina, uterus, ovaries and cervix. It also assesses urinary and bowel control and the presence of sexually transmitted infections, while providing an opportunity for contraception and pre-pregnancy counseling.