Caring for Our Bodies: Do You Need a Pap Smear This Year?
Do you wonder what that is all about? Did your doctor suddenly stop caring about you? Does that mean you can skip the gynecology visit altogether for a few years?
In 2012, several healthcare organizations (the American College of Obstetricians and Gynecologists, the American Society of Colposcopy and Cervical Pathologists, and the Society of Gynecologic Oncologists) got together to discuss and update screening guidelines for cervical cancer. This was a huge undertaking. They focused on women with a low risk of cervical cancer and set forth the recommendations by which all women's healthcare providers are expected to abide (See guidelines below).
I feel strongly in my practice that these guidelines need to be interpreted and tailored to each individual patient. Many women may fall out of the guidelines for some reason or another, and all women should be allowed to decide for themselves if they desire yearly Pap testing or evidence-based timing of their Pap. I thought I would take a moment to explain in a more public way, not just the conversation in the office when my lovely patient is already sitting on the exam table in a little gown expecting the pelvic exam with a Pap smear.
Pap testing entails brushing the cervix (or upper vagina if you have had a hysterectomy) with a spatula and brush to collect cells for microscopic examination by a pathologist to look for signs of pre-cancer or cancer. This is part of what we are doing while the speculum (metal duck bill thing) is inside of you. The sample is then scraped from the collection tools into a container of liquid that preserves the cells. The container is sent off for evaluation. From this sample, testing for certain types of human papilloma virus (HPV) can also be done. HPV is the nasty virus that is responsible for most cervical cancers.
The American medical community has done such an excellent job of screening with Pap tests that we have reduced cervical cancer incidence and mortality in this country by more than 50%.
We have learned a lot about cervical cancer during the past 30 years, and the experts in the field are attempting to reduce the burden on patients and also the cost on the healthcare system by finding a consensus on ideal screening intervals. The vast majority of cervical cancers are slow growing and would take 10 years to transform from mildly abnormal to cancer. With a common sense approach, women can reduce the number of invasive tests and procedures, while not reducing the efficacy of testing. Many women tell me, "It's not a big deal, I'd rather just have the Pap done every year for my peace of mind." This is OK with me, as with my partners also, but at some point, we need to adopt the evidence-based approach.
My goal with this blog is to put the information out there so women can see the national guidelines. This is what all obstetricians and gynecologists (OB/GYN) are tested on for board certification. So please don't think we don't care about you if we tell you that your Pap is not due this year.
Thank you for all of you who have been faithfully getting your Pap test done! But, rest assured that the changes in Pap testing recommendations are designed with you in mind. The new guidelines are not designed to limit what tests you are entitled to, or to limit what your insurance will pay for. Most insurance providers have not begun to adopt these guidelines, as a matter of fact. The biggest changes are with young women—so many of us started getting Paps as teenagers, and with senior women. The Pap recommendations are limited to just the Pap. The ideal time to start seeing a gynecologist is sometime between 13-18 years old. This is an ideal time for a meet-and-greet without an exam. Among other things, these early visits are a great chance to talk about puberty, sexuality, sexually transmitted diseases, self-respect/esteem, confidentiality, safe sex, and contraception.
We would like to have an annual visit with all women to discuss your specific risks for "female" cancers, do a breast and pelvic exam, talk about breast, vulvar and vaginal health, sexually transmitted diseases, pregnancy planning or prevention, sexuality concerns, or any other health issue on your mind. We, as obstetricians and gynecologists, are physicians specialized in taking care of you—women of every age—of your health, and especially of your reproductive health. We are here for you from when you are a teen to when you are in your senior years. Please feel comfortable in contacting one of us with your women’s health questions.
Do you need an OB/GYN or have questions about Women's Health? Call 844.316.3330 to speak to our Women's Health Nurse Navigator.