The importance of the pap test
A pap test is a screening test for cervical cancer. In the past, women were instructed to have one done every year as a way to detect abnormal cells at an early stage to help prevent cervical cancer. Over the past few years, there have been some changes to the cervical cancer screening guidelines. Unfortunately, these changes have led to a lot of confusion on the part of the patient regarding if and when a pap test was needed.
The current guidelines recommend testing women between the ages of 21-65 every three years. Routine screening is no longer recommended for women younger than 21, regardless of the age of first intercourse. Screening and treatment for sexually transmitted infections can be performed and contraceptive counseling can still be provided for younger women. Because vaginal cancer is very rare, most women who have had a hysterectomy with the removal of their cervix no longer require a pap test. Women over the age of 65 may stop the testing if they have had three negative paps in a row or have had a negative HPV test.
Almost all cases of cervical cancer are caused by HPV, the human papillomavirus. This is a very common virus that is spread during intercourse. The Gardasil vaccine (a series of three injections given between the ages of 9 and 26) gives some very good protection against HPV, but does not provide complete protection. Therefore, patients who have received the Gardasil series should still follow the current screening guidelines. Testing for HPV can be done by your provider in conjunction with your pap test. Your health care provider can guide you as to when and if this should be done.
Many patients worry that by skipping a pap test two years in a row, abnormal cells will be missed, which will increase their risk for cervical cancer. In actuality, many abnormal cells that develop are often mild, and resolve on their own without any intervention. Even if they don't resolve, it is rare for them to progress to cancer in a short time frame. Therefore, over testing patients can lead to unnecessary and invasive procedures. However, women with a current or history of an abnormal pap test may require additional or more frequent testing.
It is important to remember that these are just guidelines, not a set of strict rules to follow. Even if a pap test is not needed, it is still important to see your health care provider yearly for a well woman exam, which would still include a breast and pelvic exam. Remember, there is more to your exam than just the pap test. We all have different histories with different risk factors, so have a discussion with your health care provider to determine a schedule of testing that is appropriate for you.
Jennifer O'Doherty, certified nurse practitioner
MetroHealth certified nurse practitioner