Do I Need a Pap Smear?

Can you guess one of the most frequently asked questions I received when I was in private practice? No matter their age, nationality, or education level, women wanted to know – Do I need a pap smear?

Who can blame them? Recommendations have changed throughout the years, and once you think you’ve got it all figured out, it changes again. So, what’s the answer?  In this blog, you will finally know the answer to a question that has bewildered women for ages. But first, let’s talk about what a pap smear is.

What is a pap smear?

A Papanicolaou test, affectionately known as the pap smear, is a test that looks for abnormal cells on the cervix that can lead to cervical cancer. But did you know that now experts say that looking for abnormal cells of the cervix is not the only way to screen for cervical cancer? Let’s take a closer look at this.

What are the tests for cervical cancer screening?

There are three basic types of tests for cervical cancer screening – Cytology, HPV testing, and Cytology with HPV testing. While all these tests are performed the same way in the doctor’s office, they are tested differently in the lab.

• Cytology only (also known as the Pap smear) – Looks for abnormal cells on the cervix but does not screen for HPV. This type of cervical cancer screening is recommended for women 21-29 y/o.
• HPV testing only – Looks for high-risk strains of the Human Papilloma Virus (HPV). There are well over 100 different strains of HPV. But not all strains of HPV cause abnormalities that could potentially lead to cervical cancer. Therefore, screening only for high-risk strains of HPV, not for abnormal cells of the cervix itself, is one option for cervical cancer screening. This test can be performed on women 30–64 years old.
• Cytology with HPV testing (also known as the Pap smear with co-testing) – Combines the two methods described above. This test can be performed on women 30–64 years old as well. It basically combines the two methods mentioned above.

Therefore, in this blog, we will not use the term pap smear but instead cervical cancer screening. Now, let’s debunk five of the most common myths about cervical cancer screening.

Does age matter?

Myth #1:  You should have cervical cancer screening when you turn 18 years old.

Fact:  Women should start having cervical cancer screening at 21 years old. Even if someone becomes sexually active before then, screening for cervical cancer is not necessary until age 21.

How often do I really need to be screened for cervical cancer?

Myth #2:  Even if your cervical cancer screening is normal, you should still have to repeat your screening every single year.

Fact:  Women who have normal screenings of their cervix do not need to have yearly cervical cancer screening. I know some of you are saying, “Are you sure about that? Is that safe?” Yes, I am and yes it is!

Women who have normal screenings of their cervix may space out their screenings between 3 -5 years, depending on your age and what type of screening you had. I continue to stress normal because these guidelines do not necessarily apply to women who have had an abnormal result on their cervical cancer screening.

Let’s break this down further

• Cytology only (the pap smear) – This type of cervical cancer screening is recommended for women 21-29 y/o and is performed every 3 years if normal.
• HPV testing only – This type of cervical cancer screening only looks for high-risk strains of HPV, not abnormal cells from the cervix. It can be performed on women 30–64-year-old and is performed every 3 years if normal.
• Cytology with HPV testing (the pap smear with co-testing) – This test screens for both abnormal cells of the cervix and high-risk strains of HPV. It can be performed on women 30–64-year-old and can be performed every 5 years, instead of every 3 years.

The good thing is that you do not have to remember all of this. Your doctor will keep track of when you are due for your cervical cancer screening. The takeaway from this myth is that not every person needs a cervical cancer screening every year. This takes us into Myth #3.

How often should I see my Gynecologist?

Myth #3:  My doctor says that I do not need to have cervical cancer screening every year. Therefore, I do not need to see my gynecologist every year.

Fact:  You need to see your gynecologist every year. YOU NEED TO SEE YOUR GYNECOLOGIST EVERY YEAR. One more time for the people in the back – YOU NEED TO SEE YOUR GYNECOLOGIST EVERY YEAR. Ok. I think I have made my point.

You need to see your gynecologist every year for your annual exam even if cervical cancer screening is not needed. At an annual exam, other important things occur such as:

• Blood pressure check
• Weight check (Yeah, I hate it too.)
• Breast exam
• Pelvic Exam
• Birth control options
• Risk factor screening for medical illnesses and cancers
• Menopause discussion
• Blood work
• Ordering mammograms
• Options for colon cancer screening (colonoscopy, Cologard)
• And more!

Yearly visits help to maintain the doctor-patient relationship. This is important for many reasons. But one huge perk of being seen each year is that if you develop health concerns between your yearly visits, you won’t be considered a new patient and won’t have to wait as long to be seen. Just remember, it is important to see your doctor every year even if you don’t have cervical cancer screening performed.

I’m on my period. Now what?

Myth #4:  If you are on your period, you should cancel your yearly exam.

Fact:  If you are having CERVICAL CANCER SCREENING, it is best to reschedule your appointment. The blood obtained on the specimen can make it difficult for the pathologist to interpret the results. This means that we would need to repeat your cervical cancer screening when you are not on your period.

If you are having your ANNUAL EXAM without cervical cancer screening, you can still keep your appointment. I know it may feel embarrassing being examined while you are on your period. But let me assure you, it is ok. However, if you feel uncomfortable, you can always call to reschedule your appointment.

It is understandable that it can be confusing trying to keep up with when you are due for your cervical cancer screening. If you aren’t sure and need to know before your appointment, just call. We can let you know if your cervical cancer screening is “to be, or not to be” (thank you, Shakespeare). But whatever you do, don’t just not show up for your appointment with your doctor. Always call if you need to cancel, reschedule, or have questions about your appointment.

Can cervical cancer screening look for cancers other than cervical cancer?

Myth #5:  Cervical cancer screening lets you know if you have cervical cancer, uterine cancer, and ovarian cancer.

Fact:  Cervical cancer screening only screens for cancer of the cervix. It does not screen for any other cancers. Here are how other cancers are screened for.

• Ovarian cancer – Yearly pelvic exams can help your doctor determine if there are concerns for ovarian cancer. A pelvic exam can look for any physical signs concerning for ovarian cancer. But it is also important for you to listen to your body and report any persistent swelling/bloating and or abdominal/pelvic pain. Your family history is also an important consideration.
• Uterine cancer – If you have not gone through menopause, look for significant, persistent changes in your period such as them being heavier, longer, or more frequent. If you have already gone through menopause and have not had a period for at least one year, you should report any vaginal spotting or bleeding.
• Vulvar cancer – Once again, yearly pelvic exams with your doctor are key. Also, you should report any itching on the outside of the vaginal area that is persistent.

So, back to the original question –Do I need a pap smear?  Well let’s change that question to – Do I need cervical cancer screening? The answer is… maybe. There are a few factors that go into the correct answer for each individual woman. The takeaway message is not everyone needs to have cervical cancer screening every year, but you should still see your gynecologist every year. But do not worry if you can’t remember all the ins and outs of cervical cancer screening. That’s what we are here for!

I hope that the information shared in this blog helped to shed some light on what may be right for you. Now, you can walk with your head held up high, knowing what to do, and confidently tell your girlfriends and family what they need to do as well.

Keep in mind that recommendations could very well change again in the future. But for now, you’ve got it! Plus, you’ll be going to see your gynecologist every year anyways, right?

Dr. Kristin Williams

Medical Director of Women’s Health Specialists of North Texas

About the author: Dr. Kristin Williams is a board-certified Ob/Gyn. She graduated from Wayne State University School of Medicine in Detroit, Michigan. After completing one year of training at Tulane University in New Orleans, Louisiana, Dr. Williams moved to Dallas, Texas to complete her residency at Parkland Hospital. She worked in private practice with Women’s Health Specialists of North Texas for 16 years and now works with the office as the office Medical Director.

This blog provides general information and discussions about health and related topics. The information and other content provided in this blog, or in any linked materials, are not intended and should not be construed as medical advice. This information is not a substitute for professional medical expertise or treatment.

If you or any other person has a medical concern, please consult with your healthcare provider, or seek other professional medical treatment. Never disregard professional medical advice or delay seeking care based on the information you have read on this blog or in any linked materials. If you think you may have a medical emergency, call or go to the Emergency Room or dial 9-1-1.