Wouldn’t you think that this decision would have been decided a long time ago? This is what I love about medicine, whatever I tell you today will be wrong tomorrow. In 2004 and 2005 the guidelines regarding Pap tests have changed.

When should you start having Paps?
The old answer was age 18 or the onset of intercourse.
Today we know there is hardly any risk of cervical cancer within 5 years of the first potential exposure to HPV (Human papillomavirus, the culprit responsible for most cervical cancers) and that screening women during the first few years after starting intercourse offers no real benefit. So, our guideline today is that we start screening within 3 years of intercourse or age 21. If a virgin at age 21 then even this can be delayed.

How often should you have a Pap test?
Since 1977 the recommendation was that if you were at a low risk for cervical cancer and you had three consecutive normal Paps then the next Pap could be in 2-3 years.
Today we base frequency on your age and the type of test done. Without going into great details, suffice it to say that the general recommendation is that you should have annual Paps until age 30. After age 30, if you had three consecutive normal Pap results, you can widen the interval to 2 to 3 years.

When can you stop having Pap tests?”
Nothing much different here. It is generally recommended against doing routine Pap tests after the age of 65 as long as you have had adequate recent screening with normal Pap smears.
You can also stop having Pap smears once you have a hysterectomy for a benign disease.

You might ask “why not do a Pap every year” and thus increase your chances of discovering cancer before it becomes a problem? This is a reasonable question. The reason you may not want to have yearly Paps if you don’t have to is to prevent false positive results. Any test we do has the potential of coming back as positive when in reality it is negative. When we get a positive test it means more tests and procedures to determine if there really is a problem. More procedures increase the chances of doing harm, a risk/benefit ratio.

Because of our understanding of HPV we now have a much better idea of how cervical cancer should be screened for. We know it takes at least 5 years after exposure to develop cervical cancer. And with newer testing methods such as liquid-based cytology and an HPV test combined with the Pap it is possible that you no longer require yearly exams and can stretch them out to every 3 years.

That’s it for this week. Play hard, eat wise and I won’t need to see you at my office.