The Pap Smear: Why You Might Need It, Why You Might Not

Most women have it drilled into them that they MUST get a Pap every year, but now the annual ritual of getting a Pap smear is not necessarily annual. Initiation of Pap smears and recommendation for frequency of Pap smears have changed, and a lot of women are confused by how often they need to get one.

Guidelines are as follows:

• Pap tests should begin at age 21
• From 21-30, it is fine to get a pap every 3 years instead of annually as long as you are low risk, meaning you have never had moderate or severe dysplasia, cervical cancer, HIV, or have a severe medical illness that compromises your immune system. HPV testing is not necessary.
• After age 30, every 3 years is fine, or a combination of Pap smear and HPV testing every 5 years, if both initial tests are negative. Women with a history of dysplasia or who have other risk factors should be tested more frequently.
• After age 65, you can cross Pap smears off your “to-do” list as long as you have had a normal test for at least 10 years with the most recent test within 5 years.
• Women who have had a hysterectomy that included removal of the cervix need not continue to get Pap tests.

Why the change? Two reasons. Most abnormal Paps have minimal potential for progression to cancer. This is particularly true for young women. In the event that a persistent dysplasia is present, the transition from pre-cancerous cells to a true cancer takes not weeks or months, but years.

So does that mean you only have to see your gynecologist every three years? Sorry, no such luck. If you don’t need a Pap, you still need to have a breast exam, STD screen, and a pelvic exam to check your uterus and ovaries. And even if you don’t need cells sampled from the cervix, your gynecologist still needs to take a peek inside to make sure your cervix and vagina look healthy.

Also, keep in mind that Pap smears don’t detect 100% of abnormalities. I biopsied a suspicious growth on a patient's cervix that turned out to be an early cancer.  Her Pap smear the year before was read as normal, and had she not come in for her annual exam, I would not have seen the growth.

Even if your car is not making funny noises and no warning lights are flashing, it’s a good idea to get the oil and brakes checked annually. Your uterus, cervix and vagina deserve the same attention. After all, if your gynecologist doesn’t look in your vagina, who’s going to?