By Annie Heath, CNM
Many women have grown up hearing that an essential part of their health care includes a yearly Pap test. But in the last year, these recommendations have changed and, in this instance, the right way to take care of yourself can be confusing.
The Pap test, or pap smear, is a medical procedure in which cells are taken from a woman's cervix (the end of the uterus that extends into the vagina) with a brush or spatula and then examined under a microscope. It is a screening test that identifies abnormal cells which might indicate cervical cancer.
In the past, medical professionals did not fully understand the rolethat high-risk human papilloma virus (HPV) played in cervical cancer, the reactionof a woman's immune system and the slow nature of the disease. It is now known that high-risk strains of HPV cause just about all cases of cervical cancer.
A more comprehensive view of the causes of cervical cancer has led to new standards for Pap test screenings. The standards applyto all women, even if they have had a vaccine to help protect against high-risk strains of HPV.
The American College of Obstetricians and Gynecologists recommends:
Routine Pap test screenings for all sexually active women over the age of 21
From age 21 to 30, Pap test screenings at least every two years for those with normal Pap tests
After age 30 the frequency of Pap test screenings can be extended to every three years if a woman meets certain criteria such as three consecutive normal Pap tests, no history of cervical dysplasia, a negative test for HPV and the absence of other chronic illnesses
Annual Pap tests are still recommended for women who have a history of moderate or severe cervical dysplasia
Pap test screenings can stop between the ages of 65 and 70 if a woman has had three consecutive normal Pap tests.
Information about cervical cancer has grown tremendously over the past years. Here is a little more data about HPV, how it's contracted and how it can be treated or prevented:
There are over 100 types of HPV. In addition to cervical problems, HPV can also cause warts on various parts of the body. However, only a few strains of HPV can lead to cancer; two strains, known as 16 and 18, account for almost half of all cases of cervical cancer.
HPV is the most common sexually transmitted infection in the United States. It is estimated that 80 percent of women will be exposed to HPV, and over 50 percent of women will be infected with the virus at some point in their lives. Women at highest risk for acquiring HPV have sex for the first time early in their lives, and have multiple sex partners or a partner who has multiple sex partners.
Most HPV infections are caused by low-risk strains. There is a much smaller incidence of high-risk strains. HPV infections are usually temporary, especially in healthy nonsmoking women under the age of 21 - the woman's immune system clears the infection, often within two years.
However, among women over 30, those who smoke or those who have compromised immune systems there is a higher chance of a persistent infection that could progress to cervical dysplasia (abnormal cells of the cervix) and then possibly to cervical cancer. Cervical dysplasia does not always develop into cervical cancer. The disease improves in 91 percent of adolescents and 75 percent of adults. The progression from HPV infection to cervical cancer is very slow and can take many years.
A new vaccine, under the trade names of Gardasil and Cervarix, has been developed to help prevent the highest-risk strains of HPV.
The Centers for Disease Control recommends the vaccine for females between the ages of 9 and 29 be offered the vaccine. It is given as a series of three injections over six months. Possible side effects include pain and redness at the injection site, nausea, vomiting and headache. No long-term side effects have been noted so far.
Medical practice used to recommend aggressive intervention whenever abnormal cells were found. Procedures such as cryosurgery (freezing), electrosurgery (LEEP) and cone biopsies (surgical excisions) were often used to remove abnormal cells.
Today it is more common for providers to recommend careful observation and intervention only for severe dysplasia or persistent or worsening disease.
Pap tests can help identify cases of cervical cancer and HPV, but they are only a small part of an annual gynecological exam. Even though a woman may not need a Pap test, she should continue to have her annual exam, which includes a broad health screening, intervention and education. It is also important to discuss all of these issues with your gynecologic provider to plan what testing is appropriate for your specific health care needs.