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Dear Dr. J: The Pap Test

Dear Dr. J: I’ve switched healthcare providers and had a couple Pap tests over the last 5 years — but I think I should be getting one every year, right? This year, I’m trying to prioritize the health tasks I absolutely have to get done. Why and when do I actually need a Pap test? What does a “normal” result even mean?

Thanks for your help,
Lost me at exam


Dear Lost me at exam,

A great question, and one I’ve heard again and again from patients. Beyond uncertainty about what it tests for, the Pap test has developed a pretty bad reputation over the years. Lots of young women hear stories (or see gynecology visits gone awry in the movies) and expect a painful, uncomfortable experience.

But the reality is a quick, simple test that plays a key role in detecting precancerous cervical changes. Excitingly, several self-collection methods are in the works for women to facilitate their own cervical cancer screenings but in the meantime, the speculum exam at the gynecologist’s office remains the gold standard. It’s important, and if you’re 21 or older, cervical cancer screening should be on your checklist to discuss with your gynecologist this year.

The Pap test is specifically designed to collect and examine cells from your cervix. The test detects abnormalities or changes in those cells, caused by certain strains of the human papillomavirus (HPV), which can eventually develop into cervical cancer if left untreated for several years.

There are 3 basic result categories:

  • Normal (or Negative), which means that no cell changes were found on your cervix. Great news, but you’ll still have to get the test again in the future to make sure nothing else changes.
  • Unclear, which means that your cells could be abnormal. Your doctor will be able to advise on next steps, which usually just mean getting a separate HPV test to make sure those possible abnormalities are due to other changes (pregnancy, an infection, etc.) instead of potential cancer.
  • Abnormal, which means that cell changes were found on your cervix. This does not mean you have cervical cancer — the whole aim of the test is to catch these abnormal cells (likely caused by HPV) early, so you can get additional tests and quick treatment if you need it. Most times, low grade abnormalities resolve on their own.

At its core, the Pap smear (with or without an additional HPV test) is the best way to be proactive about preventing HPV from causing cervical cancer down the line.

As for when and how frequently you need to get the test, that depends on you! For healthy women at low risk for cervical cancer, routine can be extended to every three to five years, depending on your age.

It’s a safe recommendation, and one that can prevent you from unnecessary testing and alarm bells every year. Based on your note, it sounds like this might describe you — but check with your current healthcare provider to see what they recommend. For women under 21, the American Cancer Society, American College of Obstetricians and Gynecologists, and other governing bodies do not recommend the Pap test for the same reason. Younger women tend to have more harmless cell changes that can spur unnecessary testing and discourage general gynecology visits.

Now, women who are at a higher risk of developing cervical cancer (women with HIV, other immune system diseases, or existing precancerous cervical changes) should adhere to their providers’ management recommendations .

If you’re over 21, talk to your gynecologist about whether you need a Pap test (with or without HPV testing) this year — and even if you don’t, don’t skip out on a visit with your provider. A visit with the gynecologist involves much more than a Pap test!

To ask Dr. J your own burning (itching, “is this discharge normal?”) health question, tweet or send a private DM to @helloalphaMD



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