The Pap test is a screening tool used to find changes in the cells of the cervix that could lead to cancer. In 1948, more than 17,000 women in the U.S. died of cervical cancer. In 2009, that number was down to 4,070. Half of all women diagnosed with cervical cancer have never had a Pap test, and 10% have not had one in the past 5 years. Therefore, it is important that most women have Pap tests on a regular basis. Guidelines for cervical cancer screening are always changing based on the most current research materials available. The following recommendations are based on 2012 guidelines.
The cervix is the lowest part of uterus. The cells at the bottom layer of the cervix move to its surface. It is during this process that these cells can become damaged or abnormal. These abnormal cells may lead to cancer. The abnormal changes are referred to as dysplasia. In contrast to low-grade dysplasia, high-grade dysplasia is a precursor to cervical cancer and requires treatment. The Pap test is a simple test that can detect abnormal cervical cells. Routine Pap tests help decrease the chance that abnormal cells are missed.
Human papillomavirus (HPV) is the main cause of cervical cancer and abnormal Pap tests. It is sexually transmitted, and a woman’s immune system can usually clear the virus; however, in some women HPV will persist. Teenagers do not need Pap tests. A teenager who is sexually active and has acquired the virus has an immune system that is usually able to clear it. This usually reverses any abnormal changes of the cervix, without any medical or surgical intervention. In fact, only 0.1% of cervical cancer occurs before age 21, therefore it is recommended that women begin getting Pap tests at age 21. There is no medication available to clear the HPV virus; however, vaccines are available for women and men ages 9-26 that provide immunization against common HPV strains.
Studies have shown that women should have a Pap test every 3 years and as long as the Pap result is normal, she may continue screening every 3 years. Unlike women in their 20’s, women older than 30 are not as capable of clearing the HPV virus, therefore, for women aged 30 and over, it is also recommended to co-test for HPV. This is performed at the same time as the Pap test and can specifically detect the presence of the high-risk HPV virus. Alternatively, this co-testing can be performed every 5 years. A woman who tests positive for high-risk HPV, even with a normal Pap result, is at higher risk of developing cervical dysplasia. If she has a normal Pap test and is negative for high-risk HPV, the chance that she will develop dysplasia in the next 3-5 years is very low.
If one has had a hysterectomy, her doctor can determine the need for routine Pap tests. This may depend on why the hysterectomy was performed, whether the cervix was removed, and whether there was a history of cervical dysplasia.
It is important to differentiate a Pap test from a pelvic exam, and therefore, a woman should still visit her gynecologic provider annually, especially to evaluate other gynecologic issues such as screening and prevention of sexually transmitted infections, evaluation of external and internal organs, and family planning to name a few.
It is important to recognize that an abnormal Pap test result does not necessarily mean that cervical cancer is present. It usually means that abnormal cells have been found. Progression to cervical cancer is very slow and may take years, and often, these abnormal cells go away on their own.
But if the Pap test is abnormal a diagnostic test called a colposcopy will be performed in the office and biopsies may be necessary. The results of this test may indicate presence of normal cells, pre-cancerous changes (dyplasia) or cancer itself. There are several techniques available to remove the abnormal tissue or cancerous tissue. After treatment, follow-up testing on a more-frequent basis will be necessary. Women with a history of treatment for high-grade dysplasia or cervical cancer remain at risk for recurrence for at least 20 years. The importance of routine Pap tests cannot be stressed enough for prevention of cervical cancer.
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