Should I have a PAP Smear?

Margaret Lewin MD,
Medical Director of Cinergy Health

Guest Correspondent

The “pap smear” (Papanicolaou test) is used to screen for cervical cancer as part of the gynecological examination. It can reveal early, pre-malignant changes to the cervix. It is done by gently scraping the cervix with a wooden or plastic spatula and then by inserting a very small brush into the opening of the cervix. The cells thus obtained are then evaluated by a commercial laboratory. For maximum accuracy, your provider should be submitting a liquid-based preparation (not the old-fashioned smear submitted on glass slides). The same cells can be evaluated for the presence of HPV.

Lately, when and how often to screen has become controversial. Consensus among the various guideline commissions is still pending, but it is likely that recommendations will be as follows:

The first Pap test should be done at Age 21, then repeated every two years.
At Age 30, the Pap test and HPV screen (done using the same cells collected for the Pap) should be done; if both are negative and you’ve had at least three consecutive normal Pap smears, screening can be reduced to every three years.

If the Pap is normal but high risk HPV is present, Paps should be repeated at least yearly.

If the Pap is abnormal, further testing is necessary – starting with ‘colposcopy’. This procedure starts like a regular gynecologic examination, with the speculum inserted into the vagina. The doctor then brushes a material on the cervix to highlight any abnormal areas. The ‘colposcope’ – a large microscope positioned about a foot away – shines light into the vagina so the abnormal areas can be seen through the microscope. These areas are then biopsied and evaluated by a special laboratory.

Note: You should continue to see your doctor at least yearly for general gynecologic check-ups, even though the Pap test might be done less frequently.

Of all cancers, cervical cancer is almost unique in that it is preventable. Ask your healthcare provider whether you should consider the HPV vaccine. Cervical cancer can be detected early, treated, and cured. Ask your provider how frequently you should be screened.