As a board-certified Ob/Gyn, I often get asked the question, “Do I need a Pap every year?”
Well, the answer might be a bit long – winded. The short answer is, “Yes, you need an EXAM every year but not necessarily a Pap smear.” The long-winded answer follows below.
Let me explain and provide some background information. Since the advent of the Pap smear test, invented by a Greek biologist, Georgios Papanikolaou, an estimated 105,000 to 492,000 cases of cervical cancer have been prevented over the past three decades.
While researching the origin of the Pap smear for this blog, I found some incredible information about this man - his emergence from playing the violin at a New York restaurant to becoming a Nobel Prize nominee in 1960! Crazy, right? Initially, Papanikolaou studied medicine in Greece and served in Greek army before going to Germany for post-graduate studies in 1907. In 1913, Georgios and his wife, Andromache, emigrated to New York searching for better opportunities to further his research career. Initially they both spoke no English and had little money – she worked as a seamstress and he worked at a restaurant playing the violin. Later, he secured a research position at Cornell with his wife, Andromache, becoming his research assistant. Following years of intensive research with animal cells, Papanikolaou studied subtle changes in cells as they turned from precancerous to cancerous cells. This earned him the honor of being a Nobel Prize nominee and ranked third in 1960.
Prior to the introduction of the Pap smear, cervical cancer was once one of the most common causes of death for American women. Because of Dr. Papanikolaou’s work and the development of the Pap smear, many cervical deaths have been prevented because of the Pap smear’s ability to find changes in cervical cells (dysplasia) before cancer develops, identifying potential pre-cancerous cells early when they are small and easier to cure. Higher rates of detection of cervical dysplasia (precancerous cells), as well as the introduction of the HPV vaccine have further decreased the incidence of cervical dysplasia and cervical cancer.
According to the American Cancer Society, estimates for cervical cancer in the United States for 2019 are:
About 13,170 new cases of invasive cervical cancer will be diagnosed.
About 4,250 women will die from cervical cancer.
Most cases of cervical cancer are caused by infection with Human Papilloma Virus (HPV). HPV is a virus that causes changes in normal cells to become abnormal and potentially cancerous, known as “high risk types”, which can affect the cervix, vulva, vagina, penis, anus, mouth and throat.
According to American Board of Ob/Gyn, the following guidelines are proposed.
Women aged 21-29 years should have a Pap alone (without HPV) every 3 years.
Women aged 30-65 should have a Pap test and high-risk HPV test (known as co-testing) every 5 years (preferred). It is also acceptable to have a Pap test alone every 3 years.
Let’s get back to the initial question and the reason for my answer. I encourage all of my patients to come in for an annual exam, but they may not necessarily need a Pap smear at every visit. For many of my patients, I am considered their primary provider – the only physician or health care provider they see on a routine basis. With annual exams, I check weight, blood pressure, review any changes in family history and recent surgeries as well as new medications. Also discussed are lifestyle habits such as diet, exercise, smoking and alcohol intake. As you can see, coming to my office for an annual check-up is way more than just a PAP smear!
For the pelvic exam, I examine the external area (vulva) and surrounding skin areas, the internal tissues (vagina and cervix) and bimanual exam where I feel for the uterus and ovaries. As you can see, this is much more than just taking some cells from the cervix for a PAP smear. I’ve detected many things on pelvic exams – some life-threatening like ovarian cancer, uterine cancer and melanoma of the vulva. This is why I am so adamant about having a pelvic exam every year!
Now that you know how to be amazing with your annual exams, please visit your GYN every year – whether you are due for a Pap smear or not. Be proactive and share this information with your friends and others who could benefit from being part of our Amazing Over 40 community.