In gynecology, we like to see our patients every year for an annual check-up. One part of that check-up may be the Pap smear, but I notice that a lot of women don’t completely understand what we’re screening for and what we’re not.
A Pap smear is not a pelvic exam
Sometimes these two terms get confused, and that’s okay. A Pap smear (first developed by a Greek physician, Dr. G. Papanicolaou) is a test where the doctor takes a simple collection of cells from the end of the cervix to test for cervical cancer. A pelvic exam is a broader term, referring to any sort of internal vaginal exam. We may perform pelvic exams for a number of reasons, including abnormal periods or bleeding, pelvic pain, concerns about vaginal discharge, or sexually transmitted infection, just to name a few.
What will a Pap smear detect?
The Pap smear is designed to discover pre-cancerous cells of the cervix. That’s really it. It isn’t a screening for uterine or ovarian cancer since these organs sit further inside the body. An abnormal Pap smear, just means that there are some atypical or unexpected cells that look concerning under the microscope. For many women, we can check for the human papillomavirus (HPV) at the same time. Our lab looks for DNA associated with the highest risks strains of HPV that may cause cells to transform into a pre-cancerous state. We can also ask the lab to check for gonorrhea and chlamydia from the same collection, if recommended (women under 25, pregnant women) or requested.
What happens if my Pap smear comes back abnormal?
We grade how abnormal the cells for a Pap smear look, and this helps us decide what kind of follow up will be needed. For really mild abnormalities, especially in younger women, we’ll often just recommend repeating your screening in 12 months, giving your body time to heal itself and avoiding aggressive interventions that may not be necessary. For more concerning abnormalities, you may need to have a follow up visit for a closer look at the cervix with biopsies of any abnormal areas. When we do this, we’re trying to discover any pre-cancerous areas so they can be treated as soon as possible. The earlier we can catch an abnormal area, the less invasive and serious the recommended treatment will need to be.
How often do I need to have a Pap smear?
Average risk women need to have a Pap smear starting at age 21. Then, it’s recommended every 3 years after that, as long as results come back normal. Women who are 30 and older can start having a combination of the Pap smear with HPV testing, and if these are both negative, they can go 5 years between screenings. We don’t do Pap smears every year any longer because we’ve gotten better at identifying abnormal cells, and we’ve discovered that a lot of women just need observation instead of invasive treatment. We’re always trying to balance the prevention of cancer with putting our patients through unnecessary procedures, which may cost them time, money, anxiety, and discomfort.
A woman who may have had abnormal Pap smears in the past might need closer follow up for a time. If her screenings keep coming back normal, she can often be moved back to routine care as her risk of cervical cancer comes down, closer to an average patient’s.
Women can graduate from having Pap smears when their risk of cervical cancer gets low enough. Examples of women who may not need further Pap smears include women over 65 (as long as they’ve had good screening for the last decade) and women who have had a hysterectomy (only if it wasn’t related to abnormal Pap smears). However, you should check with your doctor to see if and when you can complete your screening.
So I don’t need to see my gynecologist every year?
Honestly, we still like to see you each year. We can talk about lots of concerns besides cervical cancer. We might need to discuss diet, exercise, sex, sexually transmitted infections, periods, menopause, smoking, blood pressure, bone health, mammograms, and any other number of concerns you or your doctor might have! You just may not need those little cells collected from the end of the cervix every time you’re in the office.
Cory Miller, MD, is board-certified in obstetrics and gynecology. He is a member of BJC Medical Group and affiliated with Progress West Hospital. Dr. Miller practices in O’Fallon, MO, and can be reached at 636-344-1073. Please consult your doctor for personal health information and questions.