Pap Tests: No longer a yearly ritual
As you have probably noticed, your annual preventive exam doesn't always include a pap test anymore. Why is this? To answer, you need to know what a pap test tests, why it’s done and what is different now.
A pap involves the collection of cells from the lowermost section of the uterus, called the cervix. The cervix is located at the top of the vagina and is accessed by inserting a speculum into the vagina, so your provider can see the area. A small brush is swept around the cervix and loose cells are caught and sent for analysis.
The cells are examined for distortions in their size, shape and nucleus. No distortion? Then, you have a normal pap. If there is cell damage, the sample is "scored" by the lab from low to high grade. The score is determined by the number of cells involved and the extent of the cell change.
We've known for a long time that an abnormal pap can evolve into cervical cancer. (It doesn't mean you have cervical cancer.) That is why it is so important to test and treat if necessary. What women don't usually know is that only a percentage of abnormal pap samples will become cancerous. Most will resolve because of the body's own immune defense. Yet, and this is the frustrating part, there is no way to predict with certainty which will heal and which will become cancerous. Generally, the higher the grade, the higher the chance it will worsen.
Pap testing began in the 1950s. At the time, no one knew what caused cervical cancer so checking at every annual exam seemed logical. In the 1980s, researchers discovered that certain strains of HPV (human papillomavirus) were the only cause of cervical cancer. HPV is a sexually transmitted virus. Approximately 18 of the 100 plus strains will cause cervical cell abnormalities. Despite this remarkable discovery we still had no way to determine who had the virus. So, pap testing every year continued.
Finally, in the mid-2000s, a DNA test detecting those critical high-risk strains of HPV became widely available for use in office practice. Knowing whether a woman has an HPV infection or not had huge implications for providers. As researchers and clinicians pooled statistics about abnormal pap results and HPV status, our understanding of how to screen for and treat cervical cell damage rapidly grew. The rules changed. New guidelines were developed that included a change in the frequency of pap testing.
As a rule, it is more difficult for women over 30 to pick up the HPV virus, so if they have no history of abnormal paps and their most recent HPV test was negative then the interval until her next pap can be as long as five years. It is much easier for women under 30 to pick up the HPV virus and it is common for them to have it. However, younger women have such robust immune systems that they clear the virus more easily than older women. Pap testing for women under 30 is done every 2-3 years. Most women 65 and older no longer need paps at all, if she's had sufficient, recent, normal pap and HPV testing. Of course, there are exceptions to these guidelines depending on a woman's medical and pap history.
Expect the rules to change again. As our understanding increases, so will the way we test and treat. And it is happening quickly.
Marte Hoffman is no longer practicing at The Everett Clinic. Find an OB/GYN provider.
DISCLAIMER: The contents and opinions expressed by Everett Clinic teammates and providers on “A Healthier You” blog and those providing comments are theirs alone and are not a substitute for medical advice. Consult your own provider for personal health recommendations.
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