The Pap Smear
Most women in the developed world are familiar with the “pap smear,” a procedure that has become an important part of routine gynecologic care. In this post we will be talking all about the pap smear: what it is, why it’s needed, and how often you should be getting it.
What is it?
The pap smear is a screening test for cervical cancer. Named after the Greek physician, Dr. Papanicolaou who invented the test in the 1940s, it is now widely used as an effective cancer prevention tool. The test involves collecting cells from the cervix (opening of the uterus) and evaluating them under a microscope to look for abnormal changes. It allows for early detection and treatment of cervical cell changes, often before they lead to cancer. Cervical cancer is very slow-growing, and pre-cancerous changes are usually present for years before a cancer develops. Testing for these pre-cancerous changes allows for treatment in the very early stages of disease, which prevents cancer from ever occurring.
Why is it important?
Before the invention of the pap smear, cervical cancer was once the leading cause of cancer death in American women. Since the 1950s, cervical cancer deaths in the US have declined by more than 70% due to the introduction of the pap smear. With routine pap smears and the HPV vaccine, over 93% of cervical cancers can be prevented.
Cervical cancer is caused by HPV
The human papillomavirus known as “HPV” is the cause of cervical cancers and can be detected in 99.7% of cases. HPV is by far the most common sexually transmitted infection in the world. Nearly all sexually active adults will be infected at some point in their lives. In most cases, HPV infection does not cause any problems and resolves on its own within a couple of years. When it does not go away, it can cause health problems like genital warts and cancer.
There are many different strains of HPV. Low-risk HPV types can cause genital warts. High-risk HPV can cause cancers of the cervix, as well as the mouth, throat, vulva, vagina, anus and penis. There is a safe and effective HPV vaccine that prevents infection from the HPV types that are most likely to cause cancer and genital warts.
How often do I need a pap smear?
Yearly pap smears were part of the well woman visit for many years. However, in 2012 updated screening guidelines were published by the United States Preventive Services Task Force (USPSTF) with less frequent screening intervals.
Cervical cancer grows very slowly, and pre-cancerous changes are typically present for years before a cancer forms. This allows screening every 3 or 5 years to catch nearly all women who need further treatment, without missing any women in the population who have cervical cancer. In a population who didn’t get the HPV vaccine, most young people will get HPV when they start having sex, but the vast majority of these HPV infections will go away on their own and will not cause cancer.
Historically, many teenage girls were getting pap smears and testing positive for HPV, which led to unnecessary invasive procedures and the emotional stress and costs associated with it. These screenings saved no lives, and diagnosed no cancers. The USPSTF now recommends not screening average risk women under age 21 for cervical cancer because the harms clearly outweigh the benefits. Similarly, cervical cancer screening is no longer recommended for women over age 65 because the potential harms outweigh the benefits.
Below are the current screening recommendations for average risk women*:
- 21 years and younger: Cervical cancer screening is not recommended
- 21 to 29: Pap smear once every 3 years
- 30 to 65: Pap smear every 3 years OR, pap smear with HPV co-testing every 5 years, OR HPV testing only every 5 years
- 65 years and older: Cervical cancer screening is not recommended if recent screenings were normal
*These recommendations do not apply to women who have a history of cervical cancer, who are immunocompromised, with in utero exposure to diethylstilbestrol, or with history of abnormal pap smears.
Although an annual pap smear is no longer recommended for most women, an annual well woman visit is still encouraged because it provides an opportunity to discuss other health-related issues with your primary care provider. To learn more about what happens during an annual wellness visit, please read this post.
What to expect
The pap smear is typically done during a well woman visit. The visit will begin with a detailed history and discussion of any concerns you may have. Your blood pressure and weight may be taken. Your provider will discuss the option of doing a clinical breast exam based on your age, symptoms, and risk factors.
The procedure is done during a pelvic exam when you are laying on your back on the exam table with your feet in stirrups. A disposable, plastic speculum will be gently inserted into your vagina so your cervix can be seen. A tiny plastic brush will be used to collect cervical cells to send to a lab for testing. The procedure itself should take no more than a few minutes and should not cause pain, although you can expect to feel some pressure and mild discomfort. It is normal to experience some light spotting after the procedure, so wearing a pantyliner or pad for the rest of the day is recommended.
How to prepare for your visit
To ensure your results are as accurate as possible, it is recommended to schedule your visit when you are not on your period. If you are having light bleeding or spotting, you may still be able to get a pap. Avoid sexual intercourse, douching, tampons, or vaginal medications for at least 48 hours prior to your visit.
Let your provider know if this is your first pap smear, if you have history of sexual assault, or if you have had negative experiences with this procedure in the past. If you are especially anxious or concerned about the procedure, you can ask your provider about using the smallest size speculum, going at a slower pace, or even inserting the speculum yourself if you prefer.
Please remember that this is about your body, and you have complete autonomy over what happens to it. If at any point you feel uncomfortable or want to stop for any reason, please let your provider know.
Preventive care is free
Cervical cancer screening is covered by all health insurance plans under the Affordable Care Act, without a copay or coinsurance. Book an appointment for your well woman visit today at Circle Medical!
Thank you to Mary McQuilkin, NP, MPH and Caitlin Swift.
