The Pap: Cervical Cancer Screening and Prevention
The Pap smear is a test that was designed to check for abnormal cells in the cervix that could eventually progress to cancerous cells. Since its development, the incidence of cervical cancer in the United States has decreased dramatically.
What is a Pap?
A Pap smear is a way of collecting cervical cells. These cells are brushed from the cervix and sent to a lab for evaluation. The lab checks for abnormal cells or “pre-cancerous” cells of the cervix.
What causes a Pap to be abnormal?
Often, abnormal cervical cells are caused by an infection with HPV (Human Papilloma Virus). HPV is a virus that is responsible for over 99% of cervical cancers. It is a sexually transmitted virus, but approximately 80% or more of the population gets infected with the virus at some point in their life. In other words, it is a very common infection. 90% of people will clear the HPV infection just like the body is able to clear a cold virus. However, sometimes the virus persists and causes cervical cells to become abnormal, a condition known as cervical dysplasia. If the body is unable to clear the virus OR if a woman is not being regularly screened with Pap smears that can recognize abnormalities and lead to treatment, these abnormal cells can progress to cancerous cells and lead to cervical cancer.
Who needs a Pap?
Historically, Paps were recommended to women by the age of 21 OR 3 years after the onset of sexual intercourse. Some experts now recommend not starting screening until the age of 21, regardless of the age of onset of sexual activity.
If I have had a hysterectomy, do I still need Paps?
Maybe. This can be dependent on why your hysterectomy was performed. However, in women who have had a total hysterectomy for benign reasons and have no prior history of high grade abnormalities of the cervix on Pap or biopsy, routine Pap screening can be discontinued. Women who have a hysterectomy without removal of the cervix should continue to have Pap tests.
You should discuss this with your physician as recommendations can vary based on your personal history. Remember that just because you may not need a Pap every year, you continue to need pelvic examinations.
When can I stop having Paps?
According the recommendations from the American Cancer Society, women 70 years of age or older who have had 3 or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having Pap tests. Remember that just because you may not need a Pap every year, you continue to need pelvic examinations.
What if my Pap is abnormal?
If your Pap smear is abnormal, your provider may recommend further evaluation with colposcopy. This involves using a microscope to look at the cervix and check for abnormalities. If an abnormality is visualized, a small biopsy can be taken. If the biopsy shows severe abnormalities, your physician can recommend treatment options.