How Often Should I get a Pap Smear?

A pap screen annually makes as much sense as an colonoscopy every year. I hope the gastroenterologists don't figure out they can offer their own "wellness" exam (say, sigmoidoscopy plus two equally silly palpation screens as the pelvic exam and clinical breast exam), or we're all in trouble.

Cervical cancer actually has a lot in common with colon cancer. Both are very slow growing, hard to detect and the screens are invasive, disgusting, humiliating and prone to errors. One field decided to recommend a screen every 10 years and the other every year. Who is right?

A Pap screen has a false positive risk of roughly five percent and a false negative rate of roughly 10 percent. Since OBGyns like false positives (more work) and don't consider either a false positive or the invasiveness of pap to be an issue, they came out with an impossible-to-defend recommendation of an annual pap. This did almost nothing to reduce an already tiny false negative risk from a three-year Pap, but created a massive false positive problem (lifetime risk is 80 percent or so with 50 annual paps). Some 22 years after the American Cancer Society said stop, the ACOG finally acknowledged what every high schooler with a stats class under the belt knew: you weren't helping women, you were hurting them. So then we get the three-year Pap. It's a step in the right direction, but three to five years is the sweet spot between the error rates for Pap and it is five years for women in their 50s through the end of screening because the HPV-to-cervical-cancer cycle lengthens.

But the bigger issue is that while getting a Pap only every three years is obviously better than a Pap every year, a fact that was obvious from the data for decades, it sucks eggs relative to HPV-DNA / Pap which is recommended every five years. Yes, there is a more accurate test that lengthens the testing interval. And honestly, while the guidelines say five years, the data actually shows neg-HPV / neg-Pap is good for at least six years.

Want better news? HPV DNA can be done on self-collected samples (and is in many other countries). Eventually the FDA will stop playing doctors trying to protect doctors and HPV DNA and sDNA will be released to the home testing market. Both will be significantly more sensitive and specific than the barbaric invasive biopsies they will replace, mainly the pap and the colonoscopy. Perhaps then the specialists administering the tests can stop pretending to the "meat" our there that these are not traumatic, etc.

By the way, one of the more disturbing elements of the Pap industry (and for the record, the Pap is the best of all the pathetic screens the ob-gyn well woman industry has) is that we have likely been screening neg-HPV, neg-Pap women living lifestyles that preclude HPV infection each and every year, using a foreign object to gain access and there's been no purpose. I refer to the dormancy theory, which the industry uses to keep these women coming back year after year. The idea is that HPV is lurking, undetectable by either Pap or HPV DNA until a time when your immune system isn't looking and then bam! The latest research suggests dormancy is rare. Further, dormancy/chronic infections of other viruses (Hep B) tends to afflict the young (vs. mature) and we know from the data this appears to be the case with HPV (i.e. more dangerous if infected while young). If the dormancy theory is discredited, then the speculum and cervical brush are going to be collecting a lot of dust.

I am still amazed how little women understand of the "wellness" industry, the limits of screening technology, where their threats lie and how their threats compare to males.

1. There is no screen for ovarian cancer. A pelvic exam is not one. There is no agreement on how one is to interpret a pelvic exam and it appears valueless in the asymptomatic (actually it's a rich source of false positives). ACOG essentially admits all this in its 2012 update, but mind-bogglingly recommends an annual pelvic exam anyway (again, it's "costless" to women and false positives are not a bad thing for them). The dirty little secret is that a pelvic exam reimburses at the highest rate compared to other procedure codes and they can do them in two to three minutes without anyone calling the quality into question. It's money (some power dynamics too).

2. We are screening young women for a mature woman's diseases. Average age at diagnosis for cervical cancers is 48, but 61 for breast cancer and 63 for ovarian.

3. A Pap screen has a false positive rate of five to 10 percent and false negative rate of 15-20 percent. Some 30 percent of new cervical cancer patients had a negative pap within the last three years. But if you overuse a crappy diagnostic, you send healthy women for colonoscopies and worse. Women need to be informed of the trade-offs so they can decide the testing interval for themselves.

4. A clinical breast exam (again, palpation is a crappy screening technology) is worthless in a mammogram population. It is also a rich source of false positives.

5. Reproductive system cancers for males are every bit as common as for women (add up testicular, prostate and compare with breast, ovarian, cervical, etc.). But males are not subjected to inspection programs that don't work nor coerced and pressured into compliance (despicably by withholding access to birth control).

6. The no. 1 killer of women is CV disease. And its rise is because of a "wellness" program that is fixated on female sexual organs. I don't care if your OB-GYN takes your blood pressure. The focus is pap, pelvic and breast exam. Either redirect the spending power elsewhere or get a new specialist (a cardiologist perhaps).

So here's the bottom line: Get a HPV-DNA /Pap every five or six years. Look for home testing options (bang on the FDA). Get your scrape from a nurse practitioner so you avoid the pressure to have a "costless" pelvic and breast exam because you're already there and you might as well and it's just part of being a woman (etc, etc). Get serious about having your lipid profiles, bp monitored, etc. None of this requires a wellness exam, much less one that is annual.

@JessicaLyn: What has a pap smear got to do with ovarian cancer? Pap smears check for cervical cancer.

Even a pelvic exam probably wouldn't have picked it up because it's only palpable once the tumour is very large.

If women are bound and determined to have a "wellness" program and require a specialist to administer it, they be best served to select a cardiologist. CV disease kills more women than all cancers combined.

This isn't about women in the final analysis. Providers have their own agenda and women aren't really the customer here -- more the currency of the realm.

Some of the posts here are simply alarming. Clearly, women’s wellness is not practicing informed consent.

1. There is no screen for ovarian cancer (thank God it’s rare). I don’t know who has been telling women a pelvic exam is such a screen but that is falsehood. Palpation is usually valueless and a rich source of false positives wherever deployed (see digital rectal exam for analogy).

2. HPV is required for cervical dysplasia and the idea that a 22-year-old virgin believes herself “high risk” is disturbing. 3. There are a lot of problems with pap smears and testing frequency is a big deal. The lifetime risk of having a false positive is 83 percent with annual exams, so don’t accept this frequency without thinking it through. Most of Europe uses a five-year testing interval. Put differently, an annual pap smear makes about as much sense as an annual colonoscopy. Remember that cervical cancer is very rare and slow growing.

4. HPV DNA testing is superior to pap straight up, and if administered concurrently with pap, extends the testing interval to six years (but you’ll hear five). Unfortunately, the FDA has not approved self-collection but research shows it’s effective (i.e., home HPV testing is on the horizon).

5. I know the industry wants to credit pap smears with the decline in cervical cancer incidence, but that may not be the case. Keep in mind that half of the 11,000 cervical cancer cases are attributed to women who are current on their pap smears. More telling, unscreened cancer incidence has declined as much if not more. It seems as likely that aspirin consumption, vigorous exercise, etc. may be responsible for the decline. It is important to note that a significant portion of women who suffer cervical cancer are immune compromised (which is why they don’t clear HPV).

@anon241913: Good for you for taking a proactive approach to your health!

Pap smears are not my favorite way to spend part of a day, but in general, they don't take long and they are rarely more than mildly uncomfortable for most people.

Hope you never have any reproductive issues!

I didn't realize it's recommended that women 18-30 have a pap smear once a year. I thought bi-annually was adequate for the under 25 group. I'm 22 and have never had a pap smear or mammogram, partly because I've never been sexually active and also because I didn't know I was in the high-risk group.

My mother had a full hysterectomy a few years ago due to uterine fibroids. In the months following she suffered vaginal prolapse, a fallen bladder, and a torn hernia, and then the early on-set of menopause. When it rains, it's time for Noah to load up the boat.

Because of all the chaos following her hysterectomy, I didn't reflect on the reproductive health problems that everything else originated from. Living on my own, working and going to school full time I didn't consider visiting an OB/GYN high priority unless I was concerned about pregnancy, birth control, VD, etc. I guess in the back of my mind, I thought I was too young to be in danger of cervical cancer or that I would notice some change that would trigger my concern and cause the need for an exam.

Well I am certainly not going to forget about it until I notice something, because if I even did it would probably too late, and I certainly don't want to risk my future chance at a healthy pregnancy -- or my chance at a healthy life -- just because I didn't spare one afternoon a year for a routine exam.

My deepest condolences and gratitude go to those who discussed their mother or other loved one who died from cervical, uterine, or ovarian cancer. You've opened my eyes more than the article itself as to the frequency and severity of the cancers and how early detection can be as easy as a 30 minute doctor's visit can be the difference between life or death.

My mother had abnormal pap smear results at the age of 40. She had early stage cervical cancer, and she ended up having to have parts of her cervix removed.

For the first two years after the surgery, she had to have pap smears every six months. Her results remained normal during that period, so the doctor reduced it down to once a year.

My mother had no problem with the frequent pap smears. I think that even if the doctor hadn’t recommended them, she would have insisted on them. Hearing that you have cancer is so scary that it motivates you to do anything in your power to get rid of it and keep it gone.

When it came time for my yearly pap smear, I was having symptoms of a urinary tract infection. I had to pee a lot more often than usual, and my bladder was cramping. Also, it burned when I peed.

I told my doctor about this before she started on the pap smear. She sent me into the bathroom with a cup for a sample. She found that I did have an infection.

She told me that she was not going to do the pap smear that day, because it would show that I had infection and throw off the results. I had to wait until I was done with my antibiotics to come back for the exam. It’s a good thing that the time between pap smears doesn’t have to be exact, because I had to take antibiotics for fourteen days.

I absolutely dread pelvic exams all year! I am over thirty and married, but my doctor still wants to do a pap smear annually. My insurance covers one exam per year, so I go through with it.

There is just something so uncomfortable about being opened up down there. What’s even weirder is the doctor and her nurse often make casual conversation with each other while I’m lying splayed out on the table. I guess for them, it’s just routine.

It doesn’t hurt when she swabs me for the pap smear, but I do feel some discomfort when she inserts that thing that opens up the canal. I have to go in a few weeks for my yearly checkup, and I’m already thinking about it.

The first exam I got for a pap smear hurt so bad! I was a virgin, and when the doctor inserted that instrument and cranked it open, I yelled out in pain. I wished I had told her to be gentle!

I had gone to her for an exam because I had some itching that would not go away. She recommended that I come back once a year, but I skipped several years, because I never wanted to feel that pain again.

Once I became engaged, I had to come back and get some birth control. I found out that in order to keep getting the pills, I would have to have an exam once a year, along with a pap smear. At least now, the exam doesn’t hurt as bad as it once did.

My doctor has a very busy schedule, so I will usually schedule my regular pap smear exam a few months in advance. The biggest disadvantage to this is not knowing if I will have to reschedule the appointment or not.

I often wondered when to get a pap smear and if they would see me when I was having my period. More than once I have had to reschedule my appointment because they didn't want to do this while I was still bleeding.

They are probably used to doing a lot of rescheduling because of this, but it can sure be a hassle sometimes.

I know that not everyone agrees with how often to get a pap smear. I always go by the recommendations my insurance company will pay for.

Every year when I call to schedule my yearly female exam, they always make sure it is scheduled at least a year after my last one.

If I were to have any kind of abnormal results and had to get tested more often, they would cover this too.

This is one exam that is easy for many women to put off or avoid altogether, but it is so important to have done on a regular basis. If something is abnormal and they catch it early, it can make all the difference.

Even if everything is OK, the peace of mind knowing that for sure is worth it to me.

Ever since I was 18 years old, I have had a pap smear every year. I have never had any abnormal cells pap smear results, but my doctor always encourages me to have this done every year.

I always dread this visit, but it doesn't take very long and I feel better knowing that everything is normal.

My doctor always sends the results of my pap smear in the mail. If I were to have any abnormal results, they would give me a phone call. I am always relieved to get my normal result in the mail and thankful that I haven't got a phone call from him.

@ElizaBennett - I see what you're saying, but I don't think over-testing is actually a problem in this country. In fact, a lot of women don't have access to affordable healthcare. I would prefer to hear about too much testing being done rather than too little.

I actually have a good friend that had ovarian cancer that could have been caught much earlier if she'd been getting her annual pap smears done. Unfortunately, she wasn't insured so she couldn't afford it. She was really out of luck when she got cancer and she's still in debt to this day. Also she only has one ovary. She may not have needed as much treatment if they had caught her cancer earlier.

@BrickBack - I'm quite surprised that your doctor mentioned douching at all. Most doctors these days don't recommend that-it can really mess your PH up and make you prone to getting more infections.

Also, you should make sure and ask your doctor if you are getting a pap smear at your visit. My mom is 57 and she was surprised to learn after she got the results of her last annual that the doctor didn't do a pap smear. When she called to get her results the receptionist let her know it's not recommended for her every year anymore so the doctor just didn't do it.

My mom was really upset because she wanted to have it done and her insurance will cover it!

@Sunny27 - I know that peace of mind is valuable, and I am so sorry about your mother's loss.

But overtesting isn't the answer - it's expensive and can be dangerous. (The more tests you take, the more likely you'll get a false positive, the more biopsies you could wind up with, etc.)

Cervical cancer is very slow-growing and your body can often clear up problems on its own. For that reason, ACOG (American Congress of Obstetricians and Gynecologists) has adopted some pretty conservative guidelines.

They suggest not starting tests until age 21. HPV is quite common under that age, but not cervical cancer, and they are concerned that testing adolescents can cause unnecessary treatments that can even affect childbearing. For instance, women who've had a cervical cone biopsy are at risk for infertility, preterm delivery, and miscarriage, a grief I wouldn't wish on anyone.

After age 21, they say get one every two years, then once every three years after age 30. That's assuming that your results are all normal and you're not high-risk.

Yes, plenty of doctors still do them every year and starting at age 18. But they hurt, and they can reveal problems that would have cleared up on their own, and they cost money - and unnecessary treatment costs even more.

*More* health care is not always *better* care!

@Sunny27-It is also important to consider the HPV vaccine if you are under 26. The HPV vaccine which is supposed to vaccinate women against the human papillomavirus virus is also linked to cervical cancer.

My doctor said that the ideal time to get a pap test is two weeks after the beginning of your menstrual cycle. He told me that you should not use any type of birth control foams or jellies in the vaginal area a few days before your appointment.

He also said that douching should not be done within a few days of your appointment because these actions tend to hide cells that are abnormal. This can cause you to have a negative Pap test result when in actuality you may really have abnormal cells that unfortunately were not detected.

I think for peace of mind it is best to get a pap smear once a year at least. Cervical cancers like many other gynecological cancers have a high survival rate if it is caught early.

The Pap smear results usually come in within a few weeks. I read that about 6% of women receive a positive pap but that does necessarily mean that they have cervical cancer.

I also read that sometimes a hormonal imbalance may also cause a positive result in the Pap test. This is why the follow up appointment is important because the doctor can single out most possibilities with additional tests.

I think that early detection is important because a doctor may uncover other problems during the exam. My mother unfortunately did not like going to the doctor and as a result died of uterine cancer because she did not seek care. This type of cancer like cervical cancer has about a 95% survival rate if caught early which is why women should get yearly exams.