Pap Smear Myths and Misconceptions
The
Pap smear is one of the most common routine medical tests that women get,
yet persistent myths and misinformation still abound. Much of the confusion
relates to publicity about various cervical screening guidelines released
in the past two to three years from the American College of Obstetricians
and Gynecologists and the American Cancer Society which vary from previous
medical standards of care. Have you heard the following?
You should have your first Pap smear at age 18. This used to
be considered "true". Latest guidelines recommend that a woman have her first
Pap smear at age 21 or within 3 years of becoming sexually active, whichever
comes first. However, all young women should discuss contraceptive options
with their physicians, ideally before becoming sexually active.
You must have a Pap smear every year. This used to be the
standard recommendation for all women. While we still recommend that you have
an internal or pelvic exam every year, the latest guidelines recommend that
all women have an annual Pap test until the age of 30. At age 30, women may
begin having the new "DNA with Pap Test" to test for HPV at the same time.
Women whose HPV test is negative and Pap smear is normal do not need to be re-tested
for 3 years. For women over 30 who only have the Pap without the HPV test,
retest annually unless:
- their last 3 Pap results were normal
- they do not have a history of serious cervical disease
- they do not have weakened immune systems and are not infected with HIV
- they were not exposed to DES while in the womb (a drug given to women to
prevent miscarriages from 1940-1970).
- If all of the above criteria are met, the interval between Pap tests, if used
alone, can be decreased to every 2 to 3 years.
You only need a Pap smear if you're sexually active. Not true.
Even though most cervical cancer is associated with HPV, which is a sexually
transmitted infection, there are reports of women who have never had sexual
intercourse who have had cervical cancer. We don't have an explanation for this
. . .yet.
You don't need a Pap smear if you've passed menopause. Not
true. In fact, one in 4 cervical cancers develops in women over 65. Since Medicare
began covering Pap smears in 1990, the incidence of invasive and noninvasive
cervical cancer in covered women has decreased significantly. However, according
to the latest cervical screening guidelines, women
no longer need to be screened for cervical cancer once they reach the age of
70 if they have not tested positive for HPV; have had at least 3 consecutive
Pap tests with normal results; have had no abnormal Pap results within the previous
10 years; have no history of cervical cancer or DES exposure; and do not have
weakened immune systems due to diseases such as HIV.
You should douche before having a Pap smear. The opposite is
true! Douching may remove some of the cells your doctor is trying to collect
on the smear. In fact, there are very few medical reasons for douching at all.
If you get a call to come in for a repeat Pap test, it must be bad
news. Not true. Many times, the sample obtained from the traditional
Pap smear is simply "inadequate"; not enough cells were obtained. This is annoying
and inconvenient for doctors and patients, but the "better safe than sorry"
advice applies here. One of the newer technologies, the ThinPrep® Pap test system
aims to reduce the number of repeat tests needed by capturing and preserving
the entire cervical sample in a container of preservative. This way, another
smear can be prepared from the same sample if necessary, rather than having
the patient return.
Pap smear results are not that reliable; cervical cancers are commonly
overlooked. Not true. In fact, if a woman gets her Pap smear annually,
the chance of an abnormality being missed over five years is less than one-one
hundredth of a percent.
You must have an annual Pap smear even if you've had a hysterectomy.
Not true. Contrary to previous medical standards of care, Cervical
cancer screening is no longer considered necessary in a woman who has a total
hysterectomy, including removal of her cervix, if it was performed for reasons
other than cancer, if she has no history of serious cervical disease and if
she was not exposed to DES (a drug used in the past to prevent miscarriages)
while in the womb. In women with a history of serious cervical disease (excluding
cancer), screening may stop if they have had no abnormal Pap results in the
past 10 years. Women who have had a "partial hysterectomy" (i.e. who still
have their cervix) should continue having Pap smears according to their physicians'
recommendations.
Created: 10/8/2000 - Donnica Moore, M.D.
Reviewed: 1/26/2005 - Donnica Moore, M.D.
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 If a woman gets her Pap smear annually, the chance of an abnormality being missed over five years is less than one-one hundredth of a percent. 
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