Question:

Why are Pap smears every five years instead of every two years?

Answer from obstetrician and gynecologist Karen Carlson, MD

As technology has improved and our cervical cancer screening tests have become more accurate, guidelines for cervical cancer screening have changed over the years. It is no longer necessary to have tests performed as frequently as in the past.

The Pap smear, which helps doctors find abnormal cells in the cervix that could become cancer, has been the standard cervical cancer screening test for years. The Pap smear was named after George Papanicolaou, MD, who discovered in the 1920s that malignant uterine and cervical tumors deposit cancerous cells into surrounding vaginal fluid.

We now know that most cervical cancers are caused by certain strains of the human papillomavirus, or HPV, the most common sexually transmitted disease in this country. HPV can cause cervical dysplasia. These are cells that look abnormal but are not cancerous. However, they increase a woman's risk of developing cervical cancer in the future. By treating these abnormalities early, you can help prevent the development of cervical cancer.

What is the HPV test?

An additional test has been added to the cervical cancer screening guidelines, called the HPV test. This test can detect the presence of high-risk HPV strains.

Over the last several years, the guidelines for screening for cervical cancer have become a little more difficult to follow for the average consumer. That’s one of the reasons why it is so important for women to stay current with their annual exams. Your provider will help you stay on top of current recommendations, including preventive screening tests and health care maintenance, based on your age and history.

Guidelines for the average-risk woman are outlined below:

How often do I need to get the Pap test?

Most organizations, including the American Cancer Society and American Society for Colposcopy and Cervical Pathology, recommend that average-risk women begin yearly exams with a Pap smear at age 21. HPV testing in this age group is not generally recommended.

Between the ages of 25 to 29, women should get the reflex Pap test. This is the same as the standard Pap test, however, if the results show atypical cells, this will be followed by an HPV test for further evaluation and management.

At age 30, we recommend women get a Pap and HPV co-test every five years until age 65.

Risk factors

If you have certain risk factors, your doctor may recommend more frequent Pap tests, regardless of your age. These risk factors include:

• A diagnosis of cervical cancer or a Pap smear that showed precancerous cell

• Exposure to diethylstilbestrol before birth

• HIV infection

• Weakened immune system due to organ transplant, chemotherapy, or chronic corticosteroid use

• Do not get regular Pap smears

How is the Pap test performed?

Most providers now perform the liquid-based cytology, a Pap test that appears to pick up precancerous abnormalities better than the former glass slide Pap smear. A Pap test is performed in your provider’s office, and it only takes a few minutes.

An instrument called a speculum is inserted into your vagina. This tool holds the walls of your vagina apart so your provider can inspect your cervix. It may cause a sensation of pressure in the pelvic area. Samples of your cervical cells are then taken using soft brushes or other scraping devices. This usually doesn’t hurt.

The collected cells are then placed into a container holding a special liquid that preserves the sample (liquid-based Pap test). The samples are then examined under a microscope to look for abnormal cells.

What does a positive test mean?

If abnormal cells are found, your test is called positive. These abnormal cells could be cancerous, or they could be slightly abnormal cells that might be precancerous.

If any of the abnormal cells are concerning, your doctor may want to perform more frequent Pap smears or further testing. This may include a colposcopy, which uses a magnifying instrument to examine the tissues of the cervix, vagina, and vulva more closely.

To better understand when you should schedule a Pap smear, contact your doctor, or call 800.922.0000 to schedule an appointment.