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WOMEN'S HEALTH: PAP SMEAR

The Pap smear is a test designed to be a simple screening test for cancer of the cervix. Cancer of the cervix at one time was a leading cause of cancer death among women. Regular Pap smear screening is credited with reducing the incidence and mortality from this type of cancer. Pap smears should be done once a year unless a recommendation is given's by one's practitioner for more or less frequent testing (see related information at the end of this article about changes in the recommendations).

Some women get confused and equate a pelvic exam with a Pap smear. A pelvic exam means that an examiner uses a speculum to look in the vagina and visualize the cervix followed usually by an exam to feel the pelvic organs. A pap smear requires cells be scraped from the cervix and placed in a collection system to be sent to an outside lab for evaluation by a special technician or pathologist. There are other laboratory tests that can be done in the office which can give us information about the presence of a vaginal infection or sexually transmitted disease; these are also different from the Pap smear.

If you are told that your Pap smear is abnormal, it does NOT mean that you have cancer . More often the Pap smear may be affected by irritation or infection in the vagina and cervix. You may be asked to come back for an examination to check for a specific infection or you may be advised to wait a number of months to repeat the Pap smear. It should be emphasized that the Pap smear is only a screening tool and does not give a diagnosis; other testing may be needed for an exact diagnosis if the cells remain abnormal. It is safe and necessary to wait months to repeat a Pap smear since the cells heal and change very slowly.

There are varying degrees of abnormality on a Pap smear and the terminology used to describe the cellular condition has changed many times in the last 60 years. Currently we are using the "Bethesda System." (see chart below) It is impossible to make a definite diagnosis from a Pap smear about the degree of abnormality and whether or not it will progress (get worse) or regress (get better). Human papilloma virus (HPV) is felt to play a major role in these cellular changes and requires another test to verify its presence in the vagina or cervix. Therefore, your practitioner will make recommendations for further testing and follow up.

Recently some of the groups that do research related to screening for cervical cancer have changed their recommendations for the frequency of Pap smear testing. It is recommended that a young woman should start getting Pap tests approximately three years after she starts having vaginal intercourse or at age 21. Regular pap tests should be done annually but the newer liquid-based tests may be done every two years. At or after age 30, women who have had three or more normal Pap smears in a row for three years need screening only once every two or three years.

Women age 70 or older who have had three normal Pap tests and no abnormal findings for the last 10 years may stop having Pap tests. Most women who have had a total hysterectomy with removal of the cervix do not need Pap tests unless the hysterectomy was done for cervical cancer or a pre-cancerous condition. While these are the general recommendations, individual health problems may warrant a change in the frequency of testing. Check with your health care provider about what regimen of testing will be best for you.

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