How Often Should I Get a Pap Test? New Guidelines for Cervical Cancer Screening

Cancer of the cervix (cervical cancer) affects many women in their reproductive years. It is estimated that in the US, about 12,000 new cases of cervical cancer will occur annually and about 4,000 women will die from the disease. Although the rate of deaths from the disease has fallen in the past decades in the US, it is still one of the leading causes of deaths in women in middle- and low-income countries.

Cervical cancer is often related to HPV (human papilloma virus) infection and both conditions often occur without symptoms. Taking a regular pap smear test is the best way to screen and diagnose these conditions. 

However, women may ask, "How often do I need a pap test?"

What is a Pap Test?

Pap smear (named after Papanicolaou, the physician who discovered the procedure) is a test used to examine samples of cells taken from a woman’s cervix. The cells, which are smeared on a glass slide are studied by a pathologist to see if there are abnormalities such as infection or malignant (cancerous) changes in the cells.

The pap test is often done as a part of a regular gynecological check-up or as a diagnostic procedure to look for abnormalities in the cervix. It is usually performed by a physician during a pelvic exam with the woman lying on her back and her legs supported by stirrups in a gynecological clinic. The test is painless but some discomfort may be experienced during the pelvic exam when it is done for the first time.

Why is a Pap Test Done?

Cervical cancer affects many adult women in their reproductive years (approximately between 20 to 50 years of age) but it usually starts without any symptoms. There is a slow progression from normal cells to precancerous (abnormal) cells to cancerous and invasive growth of cells. This malignant growth affects the lower part of the uterus which serves as the opening to the vaginal canal. The risk of developing the disease is associated with factors such as:

• human papillomavirus (HPV) infection

• multiple sexual partners

• early sexual contact

• chronic cigarette smoking

• use of birth control pills for more than five years

Read More: Will We Test for Cervical Cancer at Home?

Symptoms of cervical cancer usually include vaginal bleeding not associated with menstruation, abnormal vaginal discharge and pain. However, these symptoms are usually experienced only when the cancer is in the advanced stages. Furthermore, these symptoms may be disregarded or taken for granted as part of other conditions like bleeding after sexual intercourse or vaginal infection.

Regular pap test is therefore important for most sexually active women to screen for HPV infection, STDs and early changes or abnormalities in the cervix. This will help in the early treatment of any infection and prevent progression to the advanced stages of cervical cancer. It must be emphasized that the number of deaths from cervical cancer has dropped in recent years because of early detection and treatment owing to regular screening.

How Often Should A Pap Test Be Done?

Pap tests have helped detect changes in the cervix that could later lead to cancer, thus resulting in early diagnosis and treatment. Cancer of the cervix was once a leading cause of death among American women, but in recent decades, death rates have declined due to regular screening. Some patients and doctors think that more is better when it comes to doing these tests, and so in the past, these were done annually.

This means even women who have had their menopause also need to be tested. In the past, doctors asked patients to visit their clinics for Pap tests yearly or every two years. However, recent guidelines released by the ACS and other organizations require most women to have their Pap tests only every three years. However, there are other factors to consider when screening for cervical cancer and HPV. These include their age, gynecological history, and medical history. Furthermore, it has been found that co-testing for HPV infection, a condition which increases the risk for cervical cancer, increases the likelihood of preventing the disease when diagnosed and treated early.

Thus:

• It is recommended that healthy women aged 21 to 29 years must undergo routine Pap tests every three years.

• For women aged 30 and above, the recommended way to screen is to do a Pap test combined with HPV testing (co-testing) every five years. This procedure should continue until the age of 65.

• Another acceptable option is to get tested every three years with just a Pap test.

• Even women who have received HPV vaccinations must follow the same screening recommendations.

• Likewise, women who have stopped having children or having menstruation must still follow these guidelines.

• More frequent testing maybe needed for some women:

1. Those who have a weakened immune system due to organ transplant, chemotherapy or steroid therapy

2. Those whose mothers were exposed diethylstilbestrol (DES) while pregnant

3. HIV-positive patients, since these women are at higher risk of acquiring cervical cancer. They may need to have a pap test 6 months after an initial test, then annually thereafter if both tests are found normal.

4. Those who have abnormal test results need to be monitored more frequently for progression of the disease.

These recommendations serve as guidelines but the final decisionwith regards to the frequency and the need to perform a pap test is at best given by a doctor.

Read More: Cervical Cancer: Treatment, Symptoms and Causes

It is also important to note that too frequent screening has disadvantages, such as false positive tests, which can lead to more frequent follow up tests. These can lead to patient anxiety as well as unwanted side effects, such as problems related to future pregnancies and deliveries.