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Who Should Get A Pap Smear?

Published on 01/23/22

A pap smear, also referred to as a pap test or cervical smear is a test your OB/GYN uses to examine you for abnormal cells in the cervix (the opening between the vagina and the uterus). These tests are used to identify vaginal infections and inflammation, but mainly used to screen for cervical cancer.

Pap smears were used to help identify women who were suffering from cervical cancers since the 1950s. And for many decades following, cervical cancer was the leading cause of cancer deaths in the United States. With the help of pap smears, cervical cancer deaths have declined a whopping 60% since they became available to women’s care.

Pap smears help identify factors that help doctors detect cervical cancer early which means the likelihood of curing cervical cancer is far greater. 

When To Have a Pap Smear

Based on the U.S. Department of Health and Human Services, they have a few recommendations for the frequency of a pap smear based on a woman’s again and who have no known risks. 

Age & Frequency:

  • < 21 years old – not needed
  • 21-29 – every 3 years
  • 30-65 – every 3 years; on HPV test every 5 years, or a Pap test and HPV test together (called co-testing) every 5 years
  • 65 and older – talk to your doctor; you may no longer need Pap smear tests

Good to note this is a general rule. It doesn’t account for all women’s specific needs for a Pap smear depending on their medical history, age, and risks. Talk to your doctor about your needs and concerns to come up with a personalized plan for your medical needs.

For Women Who Are Low-Risk

A lot of women are considered low risk for cervical cancer. Cervical cancer is considered rare if a woman is younger than 21, even being sexually active. Any abnormal cells detected normally return to normal without treatment. 

Equally as rare for women over the age of 69 and have had regular pap tests with continuous normal results. Or for any woman who has had their cervix removed during a hysterectomy. Unless the hysterectomy was performed in spite of cancer or pre-cancer cells in the cervix. 

Are There Ways To Protect Yourself From Cervical Cancer?

The number one way to protect yourself against cervical cancer is to protect yourself from HPV or human papilloma virus. HPV is a sexually transmitted infection that can be the cause for cervical cancer developing in the cervix.

Ways To Reduce Your Risk

  • Use spermicidal gels. They help protect against HPV.
  • Use Condoms. Condoms help reduce the risk of getting HPV. It is less likely that you contract HPV and/or transmit HPV to your partner. However, they are not a fool-proof plan to prevent all infections. 
  • Contact your healthcare provider if you feel you are or have been at risk for contracting a sexually transmitted infection. This way your doctor can order testing and provide a full exam. 

Do Virgins Need Pap Smears?

The majority of healthcare providers recommend women begin pap smears at age 21. If you’re a virgin, or haven’t had vaginal intercorse, you may be at extreme low risk but can still consider getting tested. 

Considering sex isn’t the only way to develop cervical cancer, getting tested is still an option, even for virgins. The cells that get collected during a pap smear can detect if you have developed abnormal or cervical cancer cells that seem suspicious and need treatment. 

However, it is most cases where cervical cancer is caused by a sexually transmitted infection (or HPV). Although unlikely, there are other risk factors for developing cervical cancer such as smoking or family and medical history. Talk to your doctor if you have any concerns about possible cancers. Together you can decide what’s best for your particular situation.

Who Doesn’t Have To Consider Pap Smears?

For some women, having a pap smear test would be unnecessary. There are certain situations a woman and her doctor may consider ending pap smear testing.

  • After a complete hysterectomy.  After a total hysterectomy — surgical removal of the uterus including the cervix — removing the cervix means there’s nowhere for the cancer to develop. Therefore, ending pap smears would be a decision your doctor may make. Ask your doctor if you need to continue having Pap smears.
    If your hysterectomy was performed for a noncancerous condition, such as uterine fibroids, you may be able to discontinue routine Pap smears.
    But in the situation you had a hysterectomy for a precancerous or cancerous condition of the cervix, your doctor may recommend continuing routine Pap testing to monitor the situation for the future.
  • Older age. Doctors generally agree that women can consider stopping routine Pap testing at age 65 if their previous tests for cervical cancer have been negative.
    Discuss your options with your doctor and together you can decide what’s best for you based on your risk factors. If you’re sexually active with multiple partners, your doctor may recommend continuing Pap testing.

What If The Pap Smear Produces Abnormal Cells?

If your pap smear test results show up as a positive, doesn’t mean it’s immediately determined that you have cervical cancer. Not all positive results mean you have cervical cancer. A positive result can determine a lot of things. The answer is in the type of cells discovered in your test. 

If your test results come back positive, here are a few things your doctor may consider before cervical cancer. Depending on the situation, depends on the next course of action.

  • Atypical squamous cells of undetermined significance (ASCUS). Squamous cells are thin and flat. They normally grow on the surface of a healthy cervix. However, in the case of ASCUS, the Pap smear reveals slightly abnormal squamous cells, but the changes doesn’t necessarily mean that the cells are precancerous.
    With the liquid-based test, your doctor can re-check the sample to study the sample for additional viruses. Viruses that may promote future development of cancer. Viruses like the human papillomavirus (HPV).
    If no serious or high-risk viruses are present, the abnormal cells found as a result of the test aren’t extremely concerning. If more serious viruses are present, you’ll need further testing.
  • Squamous intraepithelial lesion. This is a term that is used to suggest that the cells collected from the pap smear may be possibly cancerous.
    If there isn’t a lot of change this means that the cell is possibly years away from becoming a cancer. This means the shape, size, and all other characteristics suggest that the lesion is cancerous, it may be early enough to detect.
    If the changes are high grade, there’s a greater chance that the lesion may develop into cancer much sooner. Additional diagnostic testing would be necessary in this case.
  • Atypical glandular cells. Glandular cells produce mucus and grow in the opening of your cervix and within your uterus. Atypical glandular cells may appear to be a little abnormal, but it can be unclear whether they’re cancerous.
    Further testing is needed to determine the source of the abnormal cells and their significance.
  • Squamous cell cancer or adenocarcinoma cells. This result means the cells collected for the Pap smear appear so abnormal that the pathologist is almost certain a cancer is present.
    “Squamous cell cancer” refers to cancers arising in the flat surface cells of the vagina or cervix. “Adenocarcinoma” refers to cancers arising in glandular cells. If these cells are found, your doctor will recommend an immediate exam.

With abnormal pap smears, your doctor may recommend a procedure called a colposcopy. Your doctor may use a magnifying instrument called a colposcope in order to examine the tissues of the cervix, vagina and vulva. 

In any area that appears abnormal, your doctor may take a tissue sample called a biopsy. The tissue sample is sent out to a laboratory to be analyzed to determine the case of the abnormal results and determine if cancer is or might be of concern. 

Pap Test Risks

Pap tests have little risk but still some nonetheless. If you have a pap smear test, you may experience. 

  • They can be uncomfortable and cause bleeding
  • Pap tests can also cause anxiety. They may produce results that don’t look normal but may go away on their own. But can lead to repeated pap tests and follow-up treatment that may or may not be needed. 

Doesn’t matter a woman’s age or stage of her life, cervical cancer can be cured when it’s caught at an early stage with a Pap smear.

Call Rosh Maternal & Fetal Medicine To Schedule A Pap Smear

The doctors at Rosh Maternal & Fetal Medicine recommend routine preventive pelvic exams and Pap smears so that you can have the peace of mind knowing that you don’t have cervical cancer. If you haven’t had a Pap smear in the last three years, call their office in the Midtown East area of New York City, or schedule an appointment online.

Talk to our team by phone or book an appointment online to get started. Call one of our six convenient NYC locations or schedule a video consultation online today. They’ve helped thousands of women. Come visit your NYC OBGYN.