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WHAT IS PAP SMEAR SCREENING FOR?
The Papanicolaou test, otherwise known as a “Pap test” or “Pap smear,” is used to screen for cervical cancer.
WHY IS IT IMPORTANT TO SCREEN FOR CERVICAL CANCER?
Cervical cancer claims the lives of over 4000 women annually in the United States. Up to 93% of cervical cancers can be prevented through Pap smear screening and HPV vaccination. Finding cervical cancer early can greatly improve a patient’s chances of survival.
CERVICAL CANCER RISK FACTORS
- High-risk human papillomavirus virus (HPV) infection
- Immunocompromised state
- Previous diagnosis of high-grade precancerous lesion or cervical cancer
- In utero exposure to diethylstilbestrol
- Human immunodeficiency virus (HIV) infection
WHAT IS THE DIFFERENCE BETWEEN A PELVIC EXAM AND A PAP SMEAR?
Pelvic exams are part of a routine physical exam for women and can be utilized during yearly physicals, pregnancy, exploring pelvic pain, and evaluating signs of infection. During the procedure, an instrument called a speculum will be inserted into the vagina to help the provider visualize the vaginal wall and cervix. At this time, the provider may perform a Pap smear. This procedure uses a brush or spatula to sample cervical cells. Pap smears are used to screen for cervical cancer by inspecting the collected cells with a microscope.
HOW OFTEN SHOULD YOU RECEIVE SCREENING?
According to the guidelines from the American Society for Colposcopy and Cervical Pathology (ASCCP) and the American College of Obstetricians and Gynecologists (ACOG), it is recommended that women start having Pap smears every 3 years, beginning at 21 years of age. After age 30 years, it is suggested that women undergo co-testing, which involves both HPV DNA testing and a Pap smear, every 5 years. However, women who are 65 years and older, or who have previously had a total hysterectomy, may not need to be screened for cervical cancer, if they have had negative screening results in the last 10 years and have not been diagnosed with moderate cervical changes in the past 25 years. It is important to discuss these options with your healthcare provider.
WHAT CAN YOU EXPECT?
Cervical cancer screening is typically a brief procedure, lasting only a few minutes. The provider will gently insert a speculum into the vagina to obtain a small sample of cells from the cervix using a soft brush or spatula. The sample is then sent to a laboratory to detect any abnormal cells and strains of HPV that may lead to cancer. Medical practitioners will usually provide clear and detailed explanations of each exam step. A Pap smear may be uncomfortable, but it should not be painful. Light bleeding after the procedure is normal, but if you experience discomfort lasting more than a few minutes or bleeding that lasts longer than 24 hours, inform your healthcare provider.
HPV VACCINATION
Gardasil 9, an HPV vaccine, can be administered to both boys and girls. It is highly effective in preventing most cases of cervical cancer, vaginal and vulvar cancer, genital warts, anal cancers, and mouth, throat, head, and neck cancers. Studies suggest that vaccinating boys against HPV may reduce transmission to girls. The vaccine is recommended for individuals ages 9 to 45 years and is most effective when administered before exposure to the virus through sexual contact. Research has demonstrated that receiving the vaccine at a young age is not associated with an earlier start of sexual activity.
SOURCES
- American College of Obstetricians and Gynecologists. Updated cervical cancer screening guidelines. www.acog.org. Accessed April 4, 2023.
- American Society for Colposcopy and Cervical Pathology. Screening guidelines. www.asccp.org/screening-guidelines.
- Mayo Clinic. HPV vaccine: who needs it, how it works. Mayo Clinic.
- National Cancer Institute. National Institutes of Health. Cervical cancer screening (PDQ)-patient version.
- . Ngo-Metzger Q, Haggstrom D, Walker J, et al. Cervical cancer screening in average-risk women: best practice advice from the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med.
- US Preventive Services Task Force. Screening for cervical cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;320(7):674-86. doi: 10.1001/jama.2018.10897