Rethinking the Pap Smear: Do You Need One Every Year?

The American Cancer Society estimated that in 2018, about 13,000 new cases of cervical cancer would be diagnosed and about 4,200 women would die from the disease. Women who don’t have access to testing or who live in countries without systematic screening are far more likely to die of cervical cancer than women in the U.S., according to Dr. Thomas Buekers, director of the division of Gynecologic Oncology and interim chair of Women’s Health at Henry Ford Hospital.

New guidelines

For women over 30, a human papillomavirus (HPV) test can replace the Pap or be used with it, according to new guidelines. That’s because certain types of HPV cause most cervical cancers, Dr. Buekers says.

Although U.S. cervical cancer screening guidelines changed in 2012, many women still haven’t heard the news. Initially, the recommendations were controversial and doctors were cautious, says Dr. Buekers. “When new guidelines come out, it takes a while before they’re commonly practiced,” he says.

Last summer, the U.S. Preventative Services Task Force confirmed its guidelines in The Journal of the American Medical Association and added a solo HPV screening option for women over age 30. The recommendations are in line with those from the American College of Obstetricians and Gynecologists and the American Cancer Society. They say most women ages 30 to 65 have three choices to screen for cervical cancer:

  • A Pap test every three years;
  • A Pap test and an HPV test every five years; and
  • Added last summer, an HPV test alone, every five years.

“My sense is most people are doing the combination,” Dr. Buekers says. “Let’s face it: Most people feel that if you do two tests, it’s better than one.”

For many women, an annual Pap test is a familiar part of their health care routine. But, Dr. Buekers says: “The data really support spacing out the screening. We probably were screening more often than we needed to.”

The new guidelines reflect test improvements and attempt to balance the benefits of early detection with problems associated with false positive results, Dr. Buekers says. For example, a false positive can lead to a certain kind of biopsy in which surgeons remove part of the cervix. That can cause complications such as excessive bleeding, infection and problems with future pregnancies, he says.

Before the Pap test was introduced, in the 1950s, cervical cancer was a leading cause of death among U.S. women of child-bearing age. “When you look at cancer through history,” Dr. Buekers says, “this has the best success record of any cancer by virtue of screening. The Pap smear prevents between 80 and 95 percent of cervical cancer deaths.”

Screening is important because early cervical cancer usually doesn’t cause symptoms. In later stages, Dr. Buekers says, women may notice symptoms such as:

  • Unusual vaginal bleeding, including after sex;
  • A darker-than-usual discharge, with a small amount of blood;
  • Pain in the pelvic area during sex or while urinating;
  • Constipation or changes in bathroom habits; and
  • Lumps in the cervix or vagina.

Such symptoms may indicate cervical cancer or other illness, Dr. Buekers says, and it’s important that women see their doctors. Dr. Buekers says he’s treated women with cervical cancer whose friends and family mistakenly assured them that their symptoms were caused by normal hormone fluctuations.

Also, some postmenopausal women don’t realize they’re still at risk for cervical cancer and need to continue screenings, he says. Those who return to dating – perhaps after a divorce or the death of a spouse – should be aware of the risk of contracting HPV from new partners, Dr. Buekers says. Using condoms can help reduce the risk, he says. Lesbians and younger women who have had an HPV vaccine also need regular screening, he says.

“The whole goal of the test is to identify precancerous cells and prevent those from developing,” Dr. Buekers says. “We’re treating it before you ever get a cancer.”

Chances are, you’ve had HPV

Papsmear snippetBy age 50, at least four out of five U.S. women have been infected with the human papillomavirus (HPV) at some point in their lives, according to the Centers for Disease Control and Prevention. It’s very common among men, too.

Although there are more than 100 kinds of HPV – the most common sexually transmitted infection in the United States – “there are just a handful that are considered high risk for cervical cancer,” says Dr. Thomas Buekers, a gynecological oncology specialist at Henry Ford Hospital.

Most people have no HPV symptoms and their immune system clears the infection on its own. “Far and away, it’s usually not a problem,” he says. But here’s another reason to stop smoking: Chemicals in cigarette smoke impair the cervix’s ability to get rid of HPV, increasing cervical cancer risk, Dr. Buekers says.

Like the shingles virus, some forms of HPV can remain dormant in your body only to appear years later, Dr. Buekers says, adding that a positive HPV test doesn’t mean anyone has cheated in a relationship. “If you develop these changes, it doesn’t mean you were infected last week,”

Dr. Buekers says. “It could have been the first time you had intercourse.” Eighty-percent of U.S. women have been infected with HPV at some point in their lives.

 Ask your doctor if you have any questions.

Categories: Get Healthy

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