Screening for Cervical Cancer- The Pap Smear

Cervical Cancer is easily prevented and detectable by having regular pap smears performed by your obstetrician-gynecologist or your primary care physician. In many cases the physician will add the HPV (Human Papilloma Virus) test to look for the presence of a virus associated with cervical and oral cancers.

It is recommended that all women begin receiving annual pap smears at age 21 or within three years of having sex, whichever occurs first. These tests should be repeated annually.  If a woman has her cervix surgically removed as part of a hysterectomy it is no longer necessary to have pap smears.  Older women who have had normal pap smears for several years in a row and have the same monogamous sexual partner for many years or are now sexually inactive , may be able to eliminate having pap smears.  Women over 30 years old with several normal pap smears and the same sexual partner may be able to spread out the pap smears from an annual event to one every two – three years.

A recent study in Sweden, published in the British Medical Journal, confirmed that women who had regular pap smears were detected with cervical cancer much earlier than those women who were not tested, and they survived the disease at a much higher rate.  While this type of test is invasive and involves extremely private anatomical areas, the data is clear that this is one screening procedure that saves lives!

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Cervical Cancer Screening Guidelines – Role of HPV Testing

The American Cancer Society says women over 30 years old who have had three normal Pap smear test results in a row can get screened every 2-3 years rather than annually. They can be screened with a conventional Pap smear test or a liquid based Pap test or the HPV (Human Papilloma Virus) test.

A recent study at Kaiser Permanente Northern California from 2003 through 2005 suggested that HPV (Human Papilloma Virus) testing may be more accurate than Pap smears. Their analysis showed that:

>  For all women with a normal Pap smear test there were 7.5 cervical cancers detected per 100,000 woman/ years.

>  For all women who were HPV-negative the rate was 3.8 cervical cancers per woman/years.

>  For women who were both HPV-negative with normal Pap smears the rate was 3.2 cervical cancers per 100,000 woman /years.

Hormuzd Katki, PhD, of the National Cancer Institute in Bethesda, Maryland recognized the increased accuracy of HPV testing over Pap testing but encouraged co-testing.

“ Most women still undergo annual screening out of habit” according to Brent DuBeshter, M.D. of the University of Rochester Medical Center in Rochester NY. Even stranger is the case of women post hysterectomy with no cervix continuing to see their gynecologists on an annual basis for pap testing?

The recommendation for annual pap smears had been present for so many years that many doctors and patients aren’t “comfortable with the new guidelines that call for screening every three years in those at low risk for cervical cancer” according to DuBeshter.  “Many providers have a hard time changing habitual practice and adopting new evidence and practice guidelines,” says Ranit Mishori, M.D. of Georgetown University School of Medicine.

What is clear is that screening every three years in low risk patients works. What will need to be determined is the evidence based role of HPV testing in conjunction with, or as a replacement for, Pap smears.