Debunking Pap Smear Myths
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 2003 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
- 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
- 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. While the Pap smear does have a fairly high
false negative rate, the fact is that if a woman gets her Pap smear annually,
the chance of an abnormality being missed over five years is less than 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: 2/28/2005  - Donnica Moore, M.D.
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