by Amy LaRue 4th year medical student edited by Dr Elise Schroeder
Why do I need a Pap?
This relatively simple test is a screening tool for cervical cancer. It is used to detect abnormal cells. Signs of abnormal cell structure, or dysplasia, indicates that the cells may be precancerous. Prior to routine PAP testing, cervical cancer was a major cause of death among women in the USA. Today, with the help of this simple screening tool and effective treatment strategies for abnormal or pre cancerous cells, cervical cancer rarely leads to death in this county. See the chart below for information on when, and how frequently you should be tested.
Why test for HPV?
99% Of cervical cancer is involves infection with HPV. The most common high-risk strains of the virus are 16 & 18 and they can be detected with DNA testing at the same time as your PAP test.
Who gets cervical cancer
The highest percentage of women diagnosed with cervical cancer are ages 30 years and older, which is why the guidelines suggest regular screening in women ages 30 to 65 and in women over 65 years old with a positive history of abnormal pap smears.
Risk factors for cervical cancer:
Information adapted from UpToDate medical reference.
- Early onset of sexual activity
- Multiple sexual partners
- A high-risk sexual partner (someone with multiple sexual partners or known HPV infection)
- History of sexually transmitted infections (i.e. Chlamydia or Genital herpes)
- History of vulvar or vaginal cancer (HPV infection is also the cause of most cases of these conditions)
- Immunosuppression (i.e. HIV infection)
When Should I get a PAP with HPV testing?
In 2012 the American Congress of Obstetricians and Gynecology (ACOG), released new recommendations for pap smears and HPV testing. There are two organizations that developed the new guidelines, one is the U.S. Preventive Services Task Force (USPSTF) and the other is a collaboration of the following agencies: American Cancer Society/American Society for Colposcopy and Cervical Pathology/American Society for Clinical Pathology (ACS/ASCCP/ASCP).
You can compare the guidelines below and discuss the recommendations with your health care provider to determine what is best for you. These recommendations are for the general population and do not apply to women with a history of cervical cancer, exposure to DES (directly or in utero) and immune-compromised patients.
| AGE | What To Test |
| < 21 | No screening |
| 21-29 | Screening with Pap every 3 years |
| 30-65 | Screening with Pap every 3 years OR Screening with Pap & HPV testing every 5 years |
| > 65 | No screening if previous tests were normal and no previous abnormal tests in past 20 years. |
| After hysterectomy | No screening in women with hysterectomy including removal of the cervix AND no history of abnormal tests or cervical cancer. |
| HPV Vaccination | Screening recommendations are the same as above. |
For more information
National Cervical Cancer Coalition
Resources
- Frumovitz, M; Goff, B; Falk, S. Invasive cervical cancer: Epidemiology, risk factors, clinical manifestations, and diagnosis. Accessed 12/15/12 from UpToDate.
- New Cervical Cancer Screening Recommendations from the U.S. Preventive Services Task Force and the American Cancer Society/American Society for Colposcopy and Cervical Pathology/American Society for Clinical Pathology.
- Cervical Cancer. National Cervical Cancer Coalition. Accessed from www.ncc-online.org/index.php/cervicalcancer on 12/14/12.