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Saturday, May 11, 2013

Do You Need The Same Pap Smear Plan As Your Friends?

Pap test guidelines are changing rapidly, as we have said in many posts. Women who have had normal pap smears, and negative HPV may not need a test yearly. You should have a pap test when your gyno recommends that you have a pap test,  because she knows your personal history; and remember, pap tests are separate from pelvic examinations. Pap tests themselves are an actual sampling of the cervix. It is designed to check for cervical cancers and not ovarian or uterine cancers. The pelvic examination checks you for conditions of the vagina, the vulva, the uterus and the ovaries. The pap smear can pick up abnormal ovarian and uterine lining cells, but that's not primarily what it is aimed to do. As for when to have the test: every year, every other year, every third year or every fifth year will depend on your age, your prior tests and whether you are getting an HPV test also. The guidelines as to when to have a pap do vary very slightly from one organization to the next and they have changed recently. So it's important if you are a mom of a young woman, ask your gyno what she currently recommends for your daughter, it's changed over what she recommended for you! The current guidelines can be summarized like this: get your first pap at age 21, and then begin getting every two years. Most studies say for those who pickup HPV, it takes about 5 years for abnormalities to be developed. So some physicians are going to recommend slightly earlier paps for those who began having sex prior to age 16. After thirty, if you are at low risk for cervical cancer, and have been getting normal pap smears, you can get pap smears even every 3 years, unless you have a negative HPV test as well, and some women can safely wait 5 years to get another pap. Although research has always said that there are cofactors to getting cervical cancer: smoking, estrogen levels, family history of cervical cancer, and possibly other infections like Herpes, none of these are factored into the current pap smear testing guidelines. Pelvic exams to screen for STDs, to check your uterus and ovaries are still done every year. By age 65 or 70, you may be low enough risk to stop pap smears. If you have had abnormal pap smears, if you have immune compromising conditions (cancer treatment for instance), or HIV, you need to keep getting pap tests every year. If you had prior CIS or high grade disease, you need a pap for another 20 years, every year. The FDA has approved adding HPV testing to your pap after the age of 30, and it is a separate test you may need to ask for as most labs are set up only to do that test reflexively if your pap test comes back ambiguous. It is now also approved to have type specific HPV testing: so not just a pap or pap plus HPV but a typing of the HPV virus to see if you have HPV 16 or 18. HPV 16 and 18 are responsible for a large percentage of cervical cancers. If you had the HPV vaccine you have been immunized against these viruses. If you had your vaccine after you had sex, you may have already picked one of these HPV types up. There is currently no specific cure for HPV although 80% resolves spontaneously, so it's important to have testing if you have had sex with a new partner in the past few years. Keep posted, as the guidelines do not yet say when to get pap tests if you have had the HPV vaccine, but we are assuming in the future they will recommend fewer pap smears if you were vaccinated.

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