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Pap Smear Guidelines - From the desk of Robert Friedman, MD.

Cervical cancer is often a preventable gynecologic cancer. The two primary screening tests for early detection of cervical cancer are the Pap test (or Pap Smear), which looks for pre-cancerous cell changes on the cervix that may become cervical cancer if they are not treated appropriately, and the HPV test, which looks for the human papillomavirus that can cause cancerous cell changes. For at least 60 years it was recommended that women receive a Pap Smear screening annually, beginning within three years of their first sexual activity. More recent guidelines have altered this recommendation dramatically, suggesting that tests should be done no more often than every 3 years, regardless of sexual history.

As of 2012, both the United States Preventive Services Task Force and the American Cancer Society provided guidelines focused on the frequency of screening, the age to begin screening, the age to stop screening, and testing for human papillomavirus or HPV, which can cause cervical cancer. They now recommend testing every 3 years for most women between the ages of 21-65, regardless of sexual history, with routine testing for women outside of this range no longer being recommended. Both groups also recommend against regular HPV screening for anyone under the age of 30 since they did not find supporting evidence to make a recommendation otherwise. Their findings are that the test is unnecessary at a younger age since most women exposed to the virus will eventually eliminate it without any intervention.

The recommendations from the authoritative groups have focused on the effectiveness of testing to reduce cancer deaths, versus potential harms that could result from the screening. Frequent Pap smear screening can result in extra false positives leading to sometimes painful biopsies and can create further risk pregnancy complications in the future, like preterm labor and low-birth-weight infants. Research has found that less frequent testing produces the same effectiveness in the reduction of cancer deaths, but reduces the potential harm of false positive tests. The recommendations apply only to healthy women.

Certain risk factors, however, may encourage a doctor to recommend Pap Smears outside of the age guidelines. More frequent testing may be requested due to a diagnosis of cervical cancer or a Pap Smear that showed precancerous cells, exposure to diethylstilbestrol (DES) before birth, HIV infection, weakened immune system due to organ transplant, chemotherapy or chronic corticosteroid use. The doctor may recommend ending Pap testing, after a total hysterectomy if the hysterectomy was for a precancerous or cancerous condition of the cervix.

It’s important to know that the only cancer for which the Pap Smear test screens is cervical cancer. It does not screen for ovarian, uterine, vaginal, or vulvar cancers. Keep in mind that any signs or symptoms that are unusual should be brought to your doctor’s attention, even in the case of receiving regular Pap screenings.

This article is provided as informational and is not intended to be a substitute for individualized professional medical advice.

From the desk of Robert Friedman, MD. This content is licensed to CCOGA provided by Doctor724 and none of this content can be reproduced, sold, or distributed in any form without permission. Please contact us with any questions at

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