Dear Dr Mitchell,
How often should I really be doing a Pap smear? Three years ago my doctor said I was fine for every three years, and a new doctor says women should be doing a smear every year. Now I'm confused. I have not had any abnormal readings, and I'm 33, with one partner and no health issues.
The Pap smear is a screening test that is done to detect precancerous cells that if left untreated can lead to cervical cancer. The abnormal cells are caused by the Human Papilloma Virus (HPV). It is usually recommended that all women from age 21 years should start doing a Pap smear every one to two years. If sexually active, the Pap smear should be done two years after regular sexual activity. There may be a need to do Pap smears more frequently if you are considered high risk. If you have been treated for an abnormal Pap smear, then a Pap smear is done every six months for two years and if the repeat Pap smears are normal then the patient can be switched back to the usual routine protocol. Women who are immunocompromised or have a high risk HPV type will also need to have more screening. This includes diabetic patients, women on steroids, and HIV-positive patients.
In developed countries where there is a comprehensive screening system in place, the incidence of cervical cancer is relatively low when compared with poor developing countries. The screening intervals for Pap smears in developed countries is usually every two to three years. However, in developing countries patients are usually screened when they show up for other gynaecological problems since there is no comprehensive screening system in place to regularly call in patients and make the Pap smear and the appropriate treatment required for the abnormal Pap smear accessible and affordable.
The use of HPV testing in women 30 years and older can also help to decrease the frequency of Pap smear screening in low-risk patients. If the patient is negative for the high-risk HPV type, then the screening interval can be extended. The four main high risk HPV types that cause cervical cancer are 16, 18, 31 and 45.
The fact that you have one partner does not mean you should not do your Pap smear because your partner could be a carrier for one of the high-risk HPV types and this will increase your risk for cervical cancer.
There are vaccines available to prevent cervical cancer, and all women from age 10 to age 55 should be vaccinated to prevent persistent HPV infection that causes cervical cancer. The vaccine is usually given in three doses over six months, but young girls can get two dosages instead of three.
Ask your gynaecologist about vaccination and ensure that you receive it. You should also continue to do your Pap smears every two to three years to pick up abnormal changes that may occur from HPV that existed prior to vaccination, or due to an HPV type that might not be covered by the vaccine.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to firstname.lastname@example.org; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. All responses are published. Dr Mitchell cannot provide personal responses.
The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.