Dr. Cheryl Serr
Cheryl Wiley, FNP

Who needs a Pap smear and how often should a Pap smear be done?

There are new guidelines regarding Pap smear screening for cervical cancer. Guidelines are issued by the U.S. Preventive Services Taskforce, the American Cancer Society, and the American College of Obstetrics and Gynecology.

What is a pap smear? A pap smear is not the same thing as a pelvic / speculum exam, but it is collected during a speculum exam, by brushing the cervix to collect cells that are then looked at under a microscope. A pap smear checks for cervical cancer and precancer. In the US cervical cancer is the tenth leading cause of cancer deaths. Smoking doubles to quadruples a woman’s risk for cervical cancer.

The new Pap smear guidelines ONLY APPLY IF ARE A LOW RISK PATIENT:

1) If you have never had severe cervical precancer (high grade HGSIL) or cancer.

2) If your mother did not take a drug called DES (diethylstilbestrol) when she was pregnant with you.

3) If you are not immune-compromised (example: HIV positive).

Other conditions that some doctors consider high risk include: smoking, prior LGSIL (mild cervical dysplasia), testing positive for high risk HPV, and being immune-compromised due to: undergoing chemotherapy or immunosuppressive therapy, chronic steroids use, alcoholism, drug abuse, malnutrition or eating disorders.

The new Pap smear guidelines ONLY APPLY TO THE COLLECTION OF A PAP SMEAR.

All women age 21 and older should still have a yearly visit and pelvic / speculum exam.

Why? To screen for other cancers (vulvar, vaginal, uterine, ovarian, breast, colon); to screen for STDs; to discuss birth control and pregnancy planning; to review prescription medications; to evaluate, discuss and treat problems like PMS, PCOS, and painful, heavy, or erratic periods; to discuss menopause, hormone replacement, and vaginal atrophy; and to discuss, screen and treat osteoporosis (bone loss).

You DO NOT need a pap smear if you are under 21 years old.                               *New Guideline*

You DO need a yearly pelvic exam if you are sexually active.

You DO need a yearly visit to renew prescription medications like birth control.

Why no pap? Because the chance of getting cervical cancer under age 21 is so very low, most precancer in young women will cure spontaneously, and treatment of abnormal Paps may cause complications in future pregnancies.

You most likely DO NOT need a pap smear if you are age 65 or older                   *New Guideline*

Specifically: not if low risk and adequate prior paps.

You DO need a yearly visit and pelvic exam.

Why no pap? Because the chance of cervical cancer after age 65 is so very low.

You most likely DO NOT need a pap smear if you have had a hysterectomy.          *New Guideline*

Specifically: not if low risk, and your cervix was removed, and the hysterectomy was NOT done for a diagnosis of cervical pre-cancer/dysplasia or cervical cancer.

You DO need a yearly visit and pelvic exam.

Why no pap? Because the chance of cervical cancer in these patients is so very low.

For women ages 21-64 our office recommends a yearly Pap smear, pelvic / speculum exam and visit.

The new guidelines say that IF you are a low risk patient you may choose to have a yearly pelvic/speculum exam and visit, but not collect a pap smear every year: (Specifically: Ages 21-29: pap every 3 years. Ages 30-65: pap every 3 years OR pap + HPV co-testing every 5 years). Not all doctors agree with these new guidelines.

Why? Because at age 21-64 you are at risk to get cervical cancer. The new guidelines will decrease the number of cervical biopsies done, but may result in a small number of cervical cancers going undetected longer.

You DO still need a pap smear if you have been vaccinated for HPV.  Why? Smoking and high risk strains of HPV are the main causes of cervical cancer. Vaccination decreases (but does not eliminate) the chance of getting cervical cancer. The vaccine protects against the most common (but not all) forms of HPV.