Do I Need A Pap Smear?

A Pap smear, named for its inventor, George Papanicolaou, is a medical test that can detect a potential case of cervical cancer before it even starts. The test is undoubtedly a life saver for many women. By some estimates, widespread use of the Pap test has cut cervical cancer deaths by 70 percent. But, based on your medical history, you might not need a Pap smear as often as you think.

What Is A Pap Smear?

A Pap smear is a very simple test. You will lie back on a table with your feet in stirrups while a doctor or nurse collects a few cells from your cervix with a tiny brush or swab. The cells are then put on a glass slide that will be sent to a laboratory.

The lab will check for abnormal cells that have at least some potential to turn cancerous.

“When you're getting a Pap smear, there's two things that are being analyzed,” said Tina Ayeni, MD, a gynecologic oncologist with Franciscan Physician Network in Indianapolis. “First, we're looking at the cells that we actually pick up from the brushing of the cervix (cytology). The second thing we're analyzing is for the presence or absence of HPV proteins. The HPV protein presence lets us know if my patient is at a higher risk or a lower risk for developing pre-cancer and cancer within a certain timeframe after the test that I've just done.”

How Often Should I Have A Pap Smear?

Most women should start having Pap tests (also called Pap smears) around age 21 and then every three to five years after that depending on your age and overall health. If you're over 65 and your doctor says you're at low risk for cervical cancer -- perhaps because you've had a long history of normal results -- you may be able to stop getting the test entirely.

“What we've learned is many women from the ages of 25-30 and above can decrease the frequency of pap smear testing if you just focus on testing for the HPV protein; you could be good for five years because HPV infection is what leads to cancer. Development of these cancers is typically a slow process. Research studies have shown that with this strategy, we detect the same number of cancers as with doing pap smears every 3 years,” Dr. Ayeni said.  Coming back for your Pap smear in five years makes sense for a certain age group of women.

“Now, not only does the HPV protein have to be negative, the Pap smear, the reading of the cells, also have to look normal. We also look at whether you've been getting your Pap smears regularly up until that point, so we often will start Pap smear screening in our younger patients around the age of 21. If you do great, no problems during your 20s into your 30s, we start to space it out because the data shows that's safe. You won't have an increased risk of cervical cancer by that change in frequency.”

Women at high risk for cervical cancer should get the test every year. You're considered high risk for cervical cancer if any of the following applies to you:

• You're HIV-positive.
• Your immune system is unusually weak (perhaps as a side effect of medications for an autoimmune disorder)
• You have had abnormal Pap tests that showed precancerous cells
• You've had cervical, vaginal, or vulvar cancer.

Insurance companies often pay for Pap smears as part of an annual pelvic exam. However, some only pay for one test every three years. If you need help paying for the test, call your local women's clinic or a city health clinic. You might even get the test for free.

What Does My Pap Smear Result Mean?

If you have an abnormal result on your pap smear, your doctor will want to run more tests. Keep in mind that "abnormal" usually doesn’t mean "cancerous." Most abnormal cells die on their own without ever turning into cancer. Further testing will help your doctor decide on the best course of action.

Doctors have a system for classifying results. Most tests come back completely normal. But here are some of the other possibilities:

• ASC (Atypical squamous cell): This means that some of the cells on the surface of the cervix (squamous cells) aren't entirely normal, but they aren't obviously precancerous, either.
• AGC (Atypical glandular cell): AGC means that there were some cells from the lining of the cervix (glandular cells) that aren't entirely normal. As with ASC, though, they aren't necessarily precancerous.
• LSIL (Low-grade squamous intraepithelial lesion): This is a mild abnormality that's caused by an infection of the human papilloma virus (HPV). It's usually harmless.
• Precancerous: This means that you have cells that likely would have turned into cancer if left on their own. You'll need further tests and treatments to protect you from real trouble down the road.
• HSIL (High-grade squamous intraepithelial lesion): These are precancerous cells that have the potential to turn into particularly aggressive cancer. Obviously, it's extremely important to get the right follow-up treatment to prevent this cancer before it starts.
• AIS (Adenocarcinoma in situ): These are precancerous cells that came from glandular tissue.
• Cancerous: In some cases, the Pap smear finds cells that have already turned to cancer. If this happens, your doctor will likely refer you to a cancer specialist (oncologist).

How Accurate Is The Pap Smear?

No screening test is perfect, the Pap smear included. In rare cases, a test may come back as abnormal even though the cells are perfectly healthy. This is known as a false positive. Or a test may come back as normal even though there were some cells that should have raised a red flag. This is called a false negative.

In each case, the mistake is usually fixed. If your test was mistakenly labeled "abnormal," follow-up tests will show that you're perfectly fine. If a test missed some abnormal cells, they should show up on your next "pap smear before they have a chance to turn to cancer.

Does Not Needing A Pap Smear Mean I Don’t Need A Pelvic Exam?

Dr. Ayeni says that even if you’re cleared for a few years between pap smears, you will still need an annual pelvic exam.

“So many of us were used to Pap smears once a year, and that's why Pap smear got synonymous to a pelvic exam,” she said. “Those are two absolutely different things. You still need a pelvic exam even if it's not time for a Pap smear. Just like we go for annual checkups of our heart, lungs, and abdomen, it is important to a woman’s health to do checkups on the pelvic organs, even after a hysterectomy.”