HOUSE CALL: Pap smear guidelines are changing


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Most women are accustomed to making an annual appointment for their pap smear. However, this tradition is changing. At your next annual exam, you may be told that you do not need a pap smear this year.

No, your doctor is not mistaken. The guidelines recently changed due to evidence showing that less frequent pap smears may be better.

You may wonder why the change? The pap smear was developed to screen for cervical cancer and it was felt that this should be performed yearly.

We have since learned that most cases of cervical cancer are caused by the Human Papillomavirus, also known as HPV. There are many types of this virus, but only a few types cause cervical cancer. This virus is sexually transmitted and is very common, so that most people will be exposed to it at some point.

Often, the immune system is able to clear the virus. Sometimes, the virus is not able to be eliminated and may eventually cause cervical cancer. The good news is that it usually takes years to develop cervical cancer. The pap smear is able to see minor changes in the cells of the cervix and hopefully catch these changes before cancer develops.

Traditionally, the pap smear only looked at the cells of the cervix for any abnormalities, known as dysplasia. However, we are now able to also test the specimen for the presence of HPV. If there is no HPV present, then the risk of cervical cancer is very low.

If your pap smear is normal and you do not have HPV, you do not need a yearly screening. If you are over the age of 30 with a normal pap smear, then you can have a repeat pap smear in five years. If you are under 30, the recommendation is for a pap smear in three years. If the cells of the pap smear are abnormal or if HPV is present, you may be referred for further testing or may continue to need pap smears every year.

You may wonder why the test shouldn't just be done anyway since we have the test. Unfortunately, the more pap smears we perform, the more abnormalities we find that would clear up on their own. This leads to treatments that may not be needed and patient anxiety. Multiple studies have shown that less frequent pap smears are just as accurate at finding cervical cancer.

Please note, this doesn't mean you should skip the annual visit with your doctor. It is still important to have a breast and pelvic exam. Your doctor also will discuss other subjects important to your health such as future fertility, menopause planning, osteoporosis prevention and thyroid testing.

Now when your doctor brings up the fact that you don't need a pap smear this year, instead of surprise you will be well informed.


Dr. Laura Bonebrake is an obstetrician/ gynecologist on staff at Missouri Baptist Medical Center and a member of BJC Medical Group. She received her medical degree from Creighton University School of Medicine. She completed a combined internship/residency in Ob/Gyn at the University of Iowa Hospitals & Clinics in Obstetrics/Gynecology.  Call 314-996-LIFE for a physician referral or appointment.

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