Pap Smears: Why and How Often?
Several risk factors can increase a woman’s risk of developing cervical cancer.
The most significant risk factor—found in more than 95 percent of cervical cancer cases—in an infection with certain strains of human papilloma virus (HPV).
Screening for cervical cancer with a pap smear should begin when a woman turns 21, and be repeated every three years until age 30. After age 30, if all Pap smears have been normal, women should have a Pap and HPV test HPV test every five years.
“Most women will be exposed to HPV as young adults,” says obstetrician/gynecologist Mary E. Fleming, MD, MPH. “For a lot of women, the body will clear the virus on its own over time. But for those who don’t, HPV can cause changes to cervical cells that can lead to cervical cancer.”
The Pap smear, performed by a gynecologist with a simple swab during a pelvic exam, is a screening test that checks for abnormalities in the cells. Since this test was introduced some 70 years ago, the number of cervical cancer cases has dropped by 75 percent.
For women whose tests show abnormailities, monitoring with another Pap smear test is often the first recommendation. If abnormalities are still detected, the next step is a colposcopy—a simple procedure performed in your gynecologist’s office that provides a view of the cervice through a medical binocular, and may or may not include a biopsy.
This is followed by close surveillance through repeat Pap tests, and sometimes requires a procedure to remove a portion of the cervix. There are two surgical procedures that accomplish this—the loop electrosurgical excision procedure (LEEP) and the cold knife conization (CKC). Both are considered minor outpatient procedures, and can be performed by your gynecologist.
“It’s important that these procedures are still steps within the prevention phase—this does not mean you have cervical cancer,” explains Dr. Fleming. “Our gynecologists address all of the precursors to cancer, including cervical, uterine, vaginal and others. If your diagnosis becomes more serious, we refer you to the gynecologic oncology department at Einstein to receive expert care and treatment.”