Who Needs a Pap Smear and When?
Women: have you had your Pap smear yet this year? We used to recommend
that all women over age 18 have a Pap smear annually. New guidelines introduced
by the American College of Obstetricians and Gynecologists (ACOG) last year
have changed that somewhat. Read the summary below to see if you are due
for your Pap smear. Regardless of whether you are or aren't, we still recommend
that all women have an annual internal or pelvic exam. During your
annual exam, you can ask your doctor if you need another Pap test, which one
you should have, and when you should have your next one. It is important
to note that these are SCREENING guidelines. That means they apply to women
who have not previously been diagnosed with cervical cancer or other cervical
diseases. In addition, women who have changed sexual partners
since their last Pap smear should call this to their doctors' attention.
While most doctors still recommend that all women over the age of 18 have
annual Pap smears with their pelvic exams, the American College of Obstetricians
and Gynecologists (ACOG) issued new, evidence-based practice guidelines regarding
Pap smear frequency in July of 2003. ACOG notes that while some women need
more frequent screening, an increasing number of women no longer need annual
cervical cancer screening. They have also noted that cervical cancer screening
can often begin later than previously recommended. This is somewhat misleading,
however, because most women associate their annual Pap smear with their annual
internal, pelvic exam. ACOG cautions that annual pelvic examinations are
still advised for all women over age 21.
ACOG's new recommendations are based in part on newly available screening
tests as well as a new appreciation for the pathology and evolution of cervical
cancer. To summarize ACOG's new recommendations:
Changes in Screening Frequency
- First Pap test: Women should have their first Pap test (a screening
of cervical cells) approximately 3 years after first sexual intercourse
or by age 21, whichever comes first.
- Women up to age 30: Women this age should undergo annual Pap testing
since women under age 30 have a higher likelihood than older women of acquiring
high-risk types of human papilloma virus (HPV) that may cause precancerous
- Women age 30 and older: ACOG says there are two acceptable screening
options for women in this age group. Under either option, women may not
need annual screening:
- Testing using Pap smears alone. If a woman age 30 or older has
negative results on three consecutive annual Pap smears, she may then
have her repeat Pap smears every 2-3 years.
- Testing using a combined Pap test with an FDA-approved test for high-risk
types of HPV: Using this new option, women receive both a Pap test
and a genetic test that looks for certain high-risk types of the human
papilloma virus (HPV), the virus known to cause 99% of cervical cancers
(HPV DNA test). If women test negative on both tests, they may have repeat
testing with the combined tests every 3 years. If only one of the tests
is negative, however, more frequent screening will be necessary.
Of course, there are exceptions to all guidelines, and these are no exception!
More frequent cervical screening may be required for higher-risk women who
are infected with HIV, are immunosuppressed (such as those receiving kidney
transplants or who take immunosuppressant medication), were exposed to DES
during their mother's pregnancy, or who were previously diagnosed with cervical
- Women who have had a hysterectomy with removal of the cervix for benign
reasons (i.e. non-cancerous) and with no history of abnormal or cancerous
cell growth may discontinue routine Pap smear testing.
- Women who have had such a hysterectomy but who have a history of abnormal
cell growth (classified as CIN 2 or 3) should be screened annually until
they have three consecutive, negative vaginal cytology tests; then they
can discontinue routine, annual screening.
- When to Discontinue Screening -- Physicians can determine on an
individual basis when a woman over 65 can stop having cervical cancer screening,
based on such factors as her medical and sexual history and the physician's
ability to monitor the patient in the future. Unfortunately, there are limited
studies of women in this age group making it difficult to set an across-the-board
upper age limit for cervical cancer screening.
- Annual Exams Continue: Regardless of the frequency of cervical
cancer screening, annual gynecologic examinations, including pelvic exams,
are still recommended.
Created: 2/14/2005  - Donnica Moore, M.D.