Screening for Cervical Cancer

The cervix is the lowest part of the uterus, opening into the vagina. Fortunately, cervical cancer incidence has decreased by 75% in the last 50 year in developed countries due to screening programs and HPV vaccination. Of women diagnosed with cervical cancer, more than half have not had appropriate pap smear screening, including 25% who never had a pap and 10% who didn’t have a pap in the last 5 years. Cervical cancer usually doesn’t have any symptoms and early cancers definitely don’t have any symptoms, leaving screening to be an important factor in preventing this type of cancer from progressing.

A pap– Papanicolaou (pap is way easier to say) – smear is when the doctor takes a small scraping of the cervix to test for cancerous or precancerous cells. Most people use the term pap smear to include the whole exam, which is often called a “well woman exam” or previously an “annual exam.” This includes a reproductive history, breast exam, pap smear and internal vaginal exam.

Every woman should start getting pap smears at age 21. Most women should have a pap smear every 3 years. This has changed from what many women were used to having as an annual exam, but who can object to spacing these out! Some insurances have started to pay for human papillomavirus (HPV) cotesting with the pap smear in women over age 30, which extends the need for a pap smear to every 5 years. Not all insurers are paying for this yet, and some insurers are actually requiring pap smears for screening more frequently than that, so don’t be surprised if your physician asks you to come in for your screening.

We don’t routinely test for HPV in women under age 30 because there are a higher number of HPV infections in this age group that the body can clear on its own, and testing can lead to unnecessary cervical biopsies. However, if a pap smear comes back abnormal, an HPV test is also run. We just don’t test for HPV independent of an abnormal pap smear.

If a pap smear comes back abnormal, you may require additional testing with colposcopy. Some primary care physicians do this procedure, but not all and a referral to a gynecologist may be required. A colposcope is used to magnify the cervix to look for abnormal areas and biopsies are taken of any concerning spots. In addition, the inside of the cervix, the endocervical canal, is usually scraped to obtain samples to test for abnormal cells as well.

Pap smears have greatly reduced mortality from cervical cancer and can detect early changes before they turn into cancer. This ten minute exam could save your life. You can spare 10 minutes every 3 years. Make sure your pap smear is up to date.