New guidelines recommend Pap tests every three years instead of annually

Many women accustomed to getting an annual Pap test for most of their adult lives were caught by surprise when medical organizations began altering their recommendations in the past couple years.

In 2012, the U.S. Preventive Services Task Force began recommending that women ages 21 to 65 have a Pap test every three years. Women who have had a hysterectomy are no longer recommended to have Pap tests, and women ages 30 to 65 may only require a Pap test every five years when the test is done in coordination with testing for HPV, or human papillomavirus, which is responsible for the majority of cervical cancer cases.

"The only time someone would fall out of the three- to five-year screening recommendation would be if they had a history of cervical dysplasia and an abnormal Pap screen within the past 10 years," says Dr. Heather Cugini, an OB/GYN at Cape Women First.

The American College of Obstetricians and Gynecologists and the American Cancer Society also have aligned their recommendations to the most recent guidelines.

So why the change in a test that women have come to expect once a year, an indicator that their reproductive organs are in good health and cancer-free?

Dr. Grant McWilliams, an OB/GYN at Cape Care for Women, explains that as researchers learned more about HPV, they realized it could be detected without a Pap test, that most women clear the disease on their own, and that the cancer takes years to develop -- so there's no real need to undergo a Pap smear every single year.

"Twenty years ago, Pap smears were the best way to detect cervical cancer," says McWilliams. "When we do a Pap smear, we are actually looking at the cells on the cervix. Then, about 10 years ago, we understood that what causes those cells to be abnormal is the HPV virus. Then we developed tests to look for different types of HPV -- certain strains of the virus cause cancer, and some don't."

Once a woman has HPV, it takes eight to 10 years for it to progress to cancer, says McWilliams, and the vast majority of women will shed the virus on their own before it leads to abnormal cervical cells or cancer. He adds that procedures to remove the abnormal cells, such as LEEP and biopsy, can shorten the cervix and lead to pre-term deliveries -- another reason to avoid unncessary Pap tests and removal of abnormal cervical cells.

"The goal is still to prevent cancer, but we can do that by screening people earlier, and just for that HPV virus," McWilliams says.

Women who do test positive for HPV may need more frequent Pap tests, and if abnormal cells are found, may need a colposcopy for a closer look at the cervical cells. Still, cervical cancer is rare and women are more likely to clear the HPV on their own.

"Women less than 21 are extremely less likely to have cervical cancer than they are to have a complication with getting or staying pregnant from a cervical procedure that may be more aggressive than necessary," says Cugini. "Women under 21 have a better chance of allowing their own immune system to resolve an active HPV infection and thereby decrease the likelihood that it will progress on to cervical changes that are precancerous."

Women should still see their doctors annually for a pelvic exam, breast exam and general wellness visit, say Cugini and McWilliams.

"The frequency of the Pap and HPV testing is not synonymous with the frequency of a pelvic exam," Cugini explains. "All women should still undergo a yearly pelvic exam, even if they have had a hysterectomy for benign reasons. There are other conditions involving the gynecologic organs and vulva/vagina that unless routinely checked for, can be as dangerous as an abnormal pap or HPV."

The annual visit also is a good time to discuss contraception, sexually transmitted infections, fertility, pelvic pain, urinary incontinence, domestic violence, and other screenings recommended by your doctor, such as mammograms, colorectal screenings and osteoporosis screenings.

"Some women only see their gynecologist as opposed to using a family doctor," adds Cugini. "These women would also benefit from scheduled blood work evaluating their blood count levels, thyroid and cholesterol."

McWilliams also advises that young women have the HPV vaccine to protect against HPV and cervical cancer. And, there's nothing wrong with asking your doctor questions and getting a second opinion if you feel uncomfortable with your treatment plan.

"Wherever you go, if something is not jiving with you, get a second opinion. Second opinions are OK," he says.