Once thought of as an annual and essential competent of a woman’s gynecological exam, the Pap (Papanicolaou) test is losing its luster
At one time it was THE necessary yearly exam in preventive women’s healthcare. The Pap, performed along with a pelvic exam, screens for cervical cancer and when appropriate the human papillomavirus (HPV). Medical professionals interpreting modern research are finding that annual screenings may produce unnecessary anxiety and cost for women without reducing cervical cancer risk.
Why did the Pap guidelines change?
Current screening recommendations are rooted in science and research. The Pap guidelines changed in 2012 in response to the growing body of evidence that we were over-screening women. With the discovery of HPV (the virus that causes most cervical cancers) and the understanding of its natural progression, we are now working smarter, not harder. Turns out, the body is typically able to fight off most HPV occurrences without the help of medicine and treatments. Just because a Pap reveals precancerous cells does not mean that the cells will, in fact, grow into cancer. In most cases (enough to reduce the Pap guidelines), they do not.
How often do you need a Pap?
Because of the newly understood research, updated screening guidelines from the American Society for Colposcopy and Cervical Pathology and the U.S. Preventive Services Task Force (USPTF) recommended a drastic reduction in Pap exams for women across all ages. Previous recommendations called for every woman over 21 to receive a Pap every year. Current guidelines now recommend that women aged 21-30 be screened every three years. Women aged 30-65 should now get a Pap plus an HPV test every five years.
In 2018 the USPSTF began recommending Pap testing with HPV co-testing every five years or Pap-testing every three years with HPV testing every five years. Women 65 and older should discuss their testing history and frequency with their doctor. Oftentimes, women who have had three consecutive normal Pap tests and no abnormal tests for 10 years may be able to eliminate HPV screening from their health routine.
Who doesn’t need a Pap? Women under 21, regardless of sexual activity, and those who have undergone a hysterectomy for reasons other than cervical dysplasia can skip the exam. That’s a lot less Paps, procedural cost, time and unwarranted anxiety, which is a good thing for both patients and physicians.
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New HPV vaccine guidelines
The human papillomavirus vaccine has emerged as a breakthrough in preventing cervical cancers. It is currently the only vaccine to prevent cancer! The HPV vaccine protects women against the two most common types of HPV that are found in over 70 percent of cervical cancers. Each year 12,000 American women are diagnosed with cervical cancer. If all girls and young women got the vaccine, we could make that number even lower.
Although the HPV vaccine works best when given before sexual activity begins (physicians suggest that girls can receive the vaccine beginning at age 11-12), adult women up to age 45 may also receive the HPV vaccine (formerly, women could receive the vaccine until age 26). The Centers for Disease Control and Prevention recommends that even boys should receive the HPV vaccine when they are 11 or 12.
It’s not that we doctors were wrong about Paps in the past, we are just adapting modern research and findings in order to best treat our patients. As always, the best course of treatment is to talk to your doctor each year to determine whether a Pap is necessary.