What is a Pap smear?
A Pap smear (also known as a Papanikolaou or Pap test) is a simple screening for cervical cancer. Since the adoption of the test by gynecologists, the number of women who developed cervical cancer has dropped dramatically worldwide.
During an exam, a small brush is used to collect a sample of cells from the surface and inner canal of the cervix. This sample is then sent to a pathologist who looks at the cells underneath a microscope to determine if the cells have a normal appearance. Results take about a week to come back.
When should I get a Pap smear and how often should I have one done?
The current guidelines recommend women start having Pap smears at age 21. For women younger than 30 years old, Pap smears should be repeated every three years if the results continue to be normal. Starting at age 30, the current guidelines recommend that along with the Pap smear, testing for the human papillomavirus (HPV) should also be done. If both the Pap smear and HPV tests are negative, screening should be repeated every five years.
While the intervals for Pap smears are 3–5 years, depending our your age, we still recommend coming in every year for a well-woman exam.
After age 65, if Pap smears have continued to be normal, we do not recommend continuing to screen for cervical cancer. Also, if a woman has had a hysterectomy and the cervix was removed, she does not need to continue to have Pap smears, unless she had a history of abnormal results prior to the hysterectomy.
The comprehensive screening guidelines can be found at www.asccp.org.
What is the relationship of Pap smear to the human papillomavirus (HPV)?
HPV is the most common sexually transmitted infection in the United States. It is the virus that causes genital warts, but it can also cause an infection of the cervix, which causes no symptoms.
There are several different sub-types of HPV and not all sub-types are associated with cervical cancer. While the majority of the cases of cervical cancer are associated with HPV, it is important to remember that not all cases are related to this virus—about 10 percent are due to other factors.
The good news about HPV is that there are vaccinations available, and they target the highest risk sub-types of HPV. The vaccinations are currently recommended for all 11 or 12 year old males and females. Additionally, women who did not get the vaccine at age 11 or 12 are eligible to still receive this vaccine up until age 26. Vaccinations for HPV will dramatically decrease future cases of cervical cancer if they are widely adopted.
Who can perform a Pap smear and where can I have one done?
A Pap smear can be performed by most primary care providers including obstetricians/gynecologists, certified nurse midwives, nurse practitioners, family medicine physicians, and internal medicine physicians. Check with your doctor’s office when making your appointment to make sure they will include this as part of your annual exam.
What happens next if my Pap smear is abnormal? What is a colposcopy?
If your Pap smear results come back abnormal, your provider will likely either recommend a repeat Pap smear in 6–12 months, or they will recommend a procedure called a colposcopy.
A colposcopy is a close examination of the cervix and vagina and is done with a microscope called a colposcope. This magnified view enables your provider to be able to see abnormal cells. If abnormal cells are visualized, biopsies are taken and processed to check for any precancerous or cancerous conditions. If precancerous or cancerous conditions are found, your provider will discuss management and treatment options for these findings.
Regular screenings are key to detecting and preventing cervical cancer. Make sure you are getting regular screenings and encouraging your daughters to see their gynecologist often.
About The Author—Matthew Clark, MD
Dr. Clark received his Bachelor of Arts degree from Brigham Young University in 2006. He then earned his Doctor of Medicine degree in 2010 at Case Western Reserve University School of Medicine and went on to complete his residency training at the Cleveland Clinic/MetroHealth Medical Center in 2014.