How Often Do I Need A Pap Smear?
January is cervical cancer awareness month, so today I want to talk about updated guidelines for pap smears. These updates are really not new (2012 for ACS, 2018 for USPSTF, 2021 for ACOG) but I still find that patients are surprised when I tell them they no longer need a pap smear every year. Some patients even push back, worried that something will be missed if a pap smear is not done every year. However, studies have shown that testing every 3 years results in similar rates of cancer detection compared to testing annually. Further, testing annually leads to about triple the number of downstream interventions like colposcopies and surgical procedures. So essentially, testing every year leads to more invasive tests/procedures without actually detecting more cancer!
In women aged 30-65, testing for HPV with the pap smear can be done instead of just doing a pap smear. With this co-testing method, paps only need to be done every 5 years. HPV is the virus that causes cervical cancer. There are several variants of HPV, and the test can detect the ones that are highest risk to cause cancer.
Pap smears can be stopped at the age of 65, if there has been adequate prior screening that has been negative. Some prefer to continue screening longer, through age 74, assuming a healthy population with a life expectancy of at least 10 years. High grade abnormalities on pap smears are actually rare in the older population of women who have had previously negative screening. If screening history is abnormal, unknown, or incomplete, then it’s best to continue to screening.
As with anything, my approach is always to have a discussion with patients about risks and benefits. Keep in mind, these are general recommendations for a healthy and low risk population. If you have conditions that place you at higher risk, such as HIV or long term immunosuppressive therapy, or a history of abnormal pap smears, then there are different recommendations to follow.
As a direct access primary care physician, I offer routine GYN care including pap smears and HPV testing if indicated.
