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    Lois McGuire, R.N., M.S.N., W.H.N.P.

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  • June 9, 2009

    Blog: Pap smear schedules vary by age, risk

    By Lois McGuire, R.N., M.S.N., W.H.N.P.

16 comments posted

The Pap smear screening test is one of modern medicine's greatest successes. In areas of the world where it's available, the Pap smear has reduced cervical cancer rates dramatically by detecting infection with human papilloma virus (HPV) and associated changes in cervical cells.

The tradition has been to do a Pap smear annually on all women. Now we are learning that we can decrease the frequency of Pap smears and still protect women.

For example, if you have never had an abnormal Pap smear and you have been with the same partner for a long time, your partner probably doesn't have HPV, so an annual Pap smear is not necessary.

The following questions and answers cover additional recent refinements in Pap smear recommendations.

When should a young woman start having Pap smears?
The recommendation is to have your first Pap smear test three years after you become sexually active or at age 21, whichever comes first. The prevalence of HPV is particularly high in young women soon after they start sexual activity. The good news, though, is that younger women have extremely low rates of invasive cervical cancer, so they usually don't need aggressive treatment for HPV infection.

After I start to have Pap smears, how often do I need them?
From the time you start to have Pap smears until age 30, we recommend a Pap smear every year. If at age 30 you are still in the dating world or have just recently become monogamous (committed to one partner), continue to have a Pap smear every year. Once you have started a long term commitment, you may begin to have a Pap smear every 3 years.

Women age 40 and above still need an annual mammogram, clinical breast examination and pelvic examination. We reduce the frequency of Pap smears, but not visits to a provider.

What if I find myself back in the dating world and I am over 30 years old?
Now you are at risk for HPV again and you should resume annual Pap smears until you are in a committed relationship.

When can I stop Pap smears?
Opinions vary, but most women can stop Pap smears at age 65 or 70 if they've had three consecutive normal Pap smears over the last ten years. But the new-partner rule still applies: Regardless of your age or gynecologic history, a new sex partner puts you at risk again, so you'll need to restart annual Pap smears.

We are all used to getting a Pap smear every year. It can feel uncomfortable to let go of this familiar schedule, but technological progress and accumulated knowledge have made it unnecessary in many circumstances. Talk to your provider each year to assess what your needs are for Pap smear screening.

16 comments posted

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  • October 27, 2009 5:41 p.m.

    I have to agree with Lisa. We need to take charge of our health and do the research for ourselves...with the internet it's not all that hard. I am 67 years old and two years ago decided to quit all testing and I feel liberated! Kathy

    - Kathy

  • October 22, 2009 6:11 p.m.

    Also....In a monogamous relationship and you can have your pap smears every three years? Ask Mark Sanford's wife when her last one was.

    - barbara

  • October 22, 2009 6:05 p.m.

    Lisa says 1000 women over 15 years need mammograms to save one woman? Well, I must have been the one woman. 49 and had to have bilateral mastectomy. NO family history, not fat, vegetarian~ (rarely fish) Don't give women a false sense of security. How many people wear seat belts and are NEVER saved by them?

    - barbara

  • October 9, 2009 10:25 a.m.

    I have never had an abnormal pap smear & had a hysterectomy that included the removal of my cervix, but kept my ovaries because they were fine. My current gyno says that I need to have a pap smear & a mommogram done annually or she will not prescribe the low dose hormone replacement that I may need. Thinking very seriously about seeking another gyno!!! Also, are there gynos who specialize in women's care who are past the pregnancy stage in their lives?

    - Sonja

  • September 28, 2009 2:09 a.m.

    This is the article that includes a chart that shows US women have FAR, FAR more pap smears than other women. http://www.mja.com.au/public/issues/176_11_030602/dic10690_fm.html

    - A great article

  • September 28, 2009 2:04 a.m.

    One last fact...don't obsess about this cancer. It is not the huge threat it's made out to be... Heart disease is the No 1 killer of women by miles, yet we rarely hear it mentioned. Cervical cancer was in decline BEFORE screening was introduced and was always uncommon. Angela Raffle, UK cervical cancer screening expert released some figures that puts the risk in context. 1000 women need regular screening for 35 years to save ONE woman from cervical cancer. 1000 women need regular mammograms for 15 years to save ONE woman. I think we should focus more on our general health, weight, exercise, choosing not to smoke etc I think it's important to look at your risk profile before agreeing to screening and an interval. Google Professor Michael Baum, UK breast cancer surgeon - he helped set up the first Breastscreen, but is now very concerned about the harm being done to healthy women and the lack of risk information. US women should also note that the annual/routine gyn exam is only recommended in the States and Germany. The vast majority of the world's doctors do not recommend them for asymptomatic women. My doctor thinks they can be harmful. (leading to more unnecessary testing & exams) Breast exams are not recommended before you're 40 either...earlier CBE's are more likely to lead to biopsies and cancer in young women is uncommon. In the US Dr's refuse the Pill unless you have an annual exam -this is a violation of your rights, they are unrelated things. Good luck!

    - Lisa

  • September 28, 2009 1:41 a.m.

    I think women need to be very careful with cancer screening. Sadly we hear the benefits of screening and not the risks. Cancer screening has risks as well as benefits and so doctors need our informed consent. Cervical cancer is uncommon. Many women are over-screened and that puts your health in jeopardy - it exposes you to an increased risk of a false positive and colposcopy/biopsies. Biopsies have risks and leave some women with physical and mental issues. (infertility, pre-term delivery, problems during pregnancy, psychosexual issues) Less is more with cervical screening. Young women need to be very careful - women under 30 carry a high risk of an abnormal result, but are very unlikely to have cancer. Cancer in this age group is rare...to contain the harm to young women, some countries don't test before 25 or 30... The country with the lowest rates of cervical cancer in the world is Finland - they also send the fewest women for biopsies. They offer screening from age 30 and then 5 yearly to age 60 They have just 5-7 tests in their lifetime while US women can face 50-70!!! Even though US guidelines have been changed to reduce the number of smears and false positives women face...many doctors still insist on annual screening. Women who are not sexually active, two virgins in a mutually monogamous relationship and women who've had complete hysterectomies for benign conditions don't need smears. Mammograms carry risks as well...be careful having them before age 50.

    - Lisa

  • September 21, 2009 12:59 a.m.

    what if i had my period and a week after ended i got another period that extended for over two weeks and i dont know if it will stop? is going to get an exam like that a bad idea? the bleeding is heavy, so i don't know if they'll be able to see anything. i am an 18-year-old virgin (no sexual toys either), so i havent done anything that could possibly cause so much bleeding like this, and i haven't been really all that stressed... im a little scared to say the least.

    - Caitlin

  • August 21, 2009 12:57 a.m.

    i am as confused as everybody here. I had my first abnormal pap smear at the age of 23 and i had only had one sexual partner. I went back for almost 2 years every 6 months until every test would come back clear for atleast a year. Until recently at the age of 27 did i have for the second time an abnormal pap test. I had a coloscopy for the second time. (uncomfortable to say the least). My new gyno. at the same medical facility explained to me that i had pre-cancerous cells but that it should clear up. She recommended i take Folic Acid vitamins to improve my immune system and that would help clear up the abnormal cells. I don't know how much that is true. Next when i asked what type of hpv i had she said it was the "high" and then walked out. so i am left confused and scared. i just know that i have to return in 4 months for a follow up pap unless told otherwise. I'm praying everything comes back normal and i can put all this behind me but I just don't know. i feel none of my friends understand what i'm going thru. can someone give me some advice. thanks

    - nancy

  • June 26, 2009 10:10 a.m.

    Dear Amy, Can you tell me more about your situation? I need to know what your biopsy stated.

    - Lois McGuire

  • June 26, 2009 10:09 a.m.

    Dear pQh7hD, I am sorry that you have not had a good experience. Find a provider that you feel comfortable with. Talk to your friends about their providers or ask the nurses in a clinic to suggest someone. Research clearly tells us that it is important to make women comfortable during their well women exam. It makes a huge difference on her willingness to seek medical advice.

    - Lois McGuire

  • June 26, 2009 10:00 a.m.

    Dear Eileen, If your hysterectomy was done because you had cancer, you will need a pap smear annually. If is was done for non-cancerous reasons and you are not sexually active or been in a long time monogomous relationship, you don't need any more pap smears. If you enter into a new sexual relationship, you will need to do pap smears again for awhile to make sure you are not exposed to any viruses from your new partner.

    - Lois McGuire

  • June 21, 2009 5:07 p.m.

    I wish doctors could continue to work on not scaring patients during and after annual pap smears. They would like more people to come in, more of them need to be patient-friendly. It might include not having scary equipment routinely in there as well. There also seems to be a lack of follow-up.

    - pQh7hD

  • June 10, 2009 8:29 a.m.

    I had a LEEP two years ago. I am in my late 40s. My gyno said no matter what, I need annual Pap smears for the rest of my life.

    - Amy

  • June 9, 2009 10:02 p.m.

    Do you need to have a pap smear after a Hysterectomy? I was told I didn't need one so I haven't had one in almost 20 years. I am now 60 years old.

    - Eileen

  • June 9, 2009 5:55 p.m.

    I have been married 35 years and only had sex with this man. 8 years ago I had a "bad" pap smear and had to have the culposcopy and then freezing of pre-cancerous cells. The doctor did not tell me then I had HPV, though she would have known that. After that treatment I went 5 years before another "bad" pap. This time the doctor (a different one) informed me that I indeed have HPV and did the culposcopy and LEEP treament on me. This is a warning that even going three years with no problem does not mean I was OK....I am disgusted with the first gyno doc for not telling me the truth. My husband had been unfaithful sexually 10 years ago and had not told me, nor did I suspect anything. Sexual contact is the only way to get HPV.

    - carol

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