How often do you get a pap test? If you're getting one every year, you may be over-testing if you are not at high risk. You see, even the American Cancer Society admits that annual testing via a pap test is OVER-TESTING, and offers little benefit (if any at all).
But there are harms to screening more frequently. False positives are very common with cervical cancer screening, and more frequent screening leads to more frequent need for follow-up tests that can be invasive and have unwanted side effects, including problems related to future pregnancies and delivery, as well as increased anxiety and time away from work or home." -American Cancer Society
What is a pap test?
The pap test scrapes cells from a women's cervix and then checked for abnormalities. In more technical terms,
"The Papanicolaou test (also called Pap smear, Pap test, cervical smear, or smear test) is a method of cervical screening used to detect potentially pre-cancerous and cancerous processes in the Canal of the cervix (transformation zone) of the female reproductive system. Unusual findings are often followed up by more sensitive diagnostic procedures, and, if warranted, interventions that aim to prevent progression to cervical cancer. The test was invented by and named after the prominent Greek doctor Georgios Papanikolaou." -Wikipedia
What about the annual exam?
Not needing an annual pap test does not mean that you don't need to go in for an annual exam. There are still reasons to go per what is right for you and your doctor's recommendations. Hopefully not having an annual pap will allow MORE time with your doctor to address other concerns!
Pap test recommendations
According to the American Cancer Society, "Screening with the Pap test alone every 3 years is extremely safe and will decrease the number of false-positive results without leading to an increase in cancer or cancer deaths."
This handout from the American Congress of Obstetrics and Gynecologists goes into more detail or you can check out this one from the CDC.
Why less testing?
Cervical cancer develops very slowly, usually taking about 10-20 years to develop, so testing for those people who are low-risk every 3 years still provides sufficient time to catch it early.
Are doctor's offices following suit?
Have you heard about the motion for less testing from your doctor? I hadn't. This makes me think that doctors are still recommending one every year as the "norm."
How do you feel about this? I'm excited to get one less test every year, what about you?
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References:
http://www.cancer.org/cancer/news/expertvoices/post/2012/03/14/is-a-pap-test-necessary-every-year.aspx
http://www.cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-prevention
http://en.wikipedia.org/wiki/Pap_test
https://www.acog.org/-/media/For-Patients/pfs004.pdf?dmc=1&ts=20160817T1858249837
Brittany, RN
I am a Registered Nurse in a primary care clinic in Minnesota. What you have listed above is the standard of care. OF COURSE, not everyone falls into the above chart. If you have a family history of cervical cancer or a history of an abnormal pap, your primary care provider may still want to have a pap done annually. The women's health providers that I work with also recommend a pelvic exam annually so that your pcp can visually inspect your vagina/cervix for abnormalities.
Lisa
I was going to say the same thing. I am 35 and living in MN. Because I have never had an abnormal result, the standard protocol here is that I don't need annual testing; my provider also follows the above chart. Maybe we are lucky here in MN? Are there states where annual pap tests are recommended for all women, contrary to the recommendations from the American Cancer Society?
Jade
I am 21 years old and no one in my family has had cervical cancer but yet when I turned 16 I was told I should get one every year. I also do no have any other conditions that would need to be checked. The only thing that ever happens to me are simple bladder infections.
Doctors do tell you to get an annual pap done even without preexisting conditions, it's ridiculous
Sherri
The only reason I can think that your physican would suggest that you have a pap test every year would be because you are sexually active. It is my expressed opinion that it would not be necessary if you were not active. My teens (15 & 16) have never had a pap test nor would they need one at this time. Should a physican suggest this I would refuse and be searching for a new care provider.
Mary m
Total bull shit I haven't done any exams and I'm 45... No plans to either not buying into the fear based bull
RespectMe
Speak!! This practice was thought up my a misogynistic bastard! There are more reliable blood tests to test for this. Violated women is not the answer. We deserve to be respected! I was bullied into getting one last year. I still feel violated, I’ll never get one again! They lead us to believe that is someone even looks at us we will get cervical cancer! Not the case at all!
Marisa
I absolutely agree with both of you (RespectMe and Mary m) - as people we have a RIGHT to decide for ourselves what procedures we endure and which ones we don't. I won't be bullied or scared into doing something.
I've also been through a lot of trauma in my life - I"m not about to add to it.
Victoria
I am almost 30. I have only ever had 1 pap smear and it was after my first child who is now 2.5 years old. It was normal and i don't care to have another for a few years yet. I will have another most likely before I'm 35.
Jen
Actually when I had my annual exam done this year, my gynecologist told me that the recommendations had changed and that I would only need a pap once every 3 years. Honestly it makes no difference to me if you still have to go in there and undergo the uncomfortable process of a physical exam anyways. blah......
Kim
Thanks for writing this post, questioning what is assumed by most women to be an absolute necessity. Have you ever noticed how women use the verb "have to" when talking about getting a PAP, rather than "should", "considering", or "might".
What we forget, is that women lived and thrived for thousands of years before this test was invented. We forget to consider the possible psychological and spiritual repercussions of the annual invasion of such a sacred and vulnerable part of ourselves. How many of us have suppressed our natural and valid feeling of violation after a pelvic examination?
No one can mandate that you get a pelvic exam any more than they can that you visit the dentist or get a vaccination. I encourage women to mindfully reflect on how they allow "professionals" and "experts" to dictate how the most mysterious and sacred part of their bodies is treated.
Catherine
Well said Kim--I could not agree more!
Catherine
tina
Although we as a nation are over tested do not forget in the natural days female death rate was sky high and mostly GYN/ Pregnancy issues. Over 20,000 women are DX'ed with cervical cancer in the US each year. Most is way early and could even wait years for treatment BUT if you want a gruesome read of how painful and horrible death by cervical cancer, read about Henrietta Lacks, the cancer cells in her are in a lot of research (the point of the book) but it also gives grim details of life before routine and probably over done PAP tests.
Lisa
I agree. Because of the high rates of HPV and other illnesses, plus our much higher risk for cancer overall, screening regularly for cancer and other ailments is not a bad idea. No, people did not do it 200 years ago, but they would have if they'd had the option. I think we are very fortunate to have the option available to us and I am pretty grateful for the advances of medical technology We have the power to be informed and aware of what is going on in our bodies and we also have the freedom to choose what we do and don't do.
Mary m
Lol what research lab or gym do you work for?
Cindy
I love this comment. It expresses exactly how I felt after my last Pap smear - performed by a woman! It was a humiliating experience, provided with no sensitivity or tact whatsoever, and I was left feeling defiled and violated, and feeling silly for feeling that way. I'm disinclined to have another exam unless valid medical reasons relevant to me present themselves, as with mammograms.
AmericanTruth
What they don’t tell you are there are more reliable blood tests. They choose to humiliate and scare women. This exam way was brought about by a misogynist
Jen
This past year, at home, self collected, mail-in HPV testing became approved in the US. I recently did my own. If I had not been HPV negative, I would have been contacted by a telehealth professional to discuss follow-up testing and the possibility of cancer. I read that clinical trials of self collected vaginal swabs vs physician collected cervical swabs came out about equal, so...we finally have options. (Though I think the recommendation is still for women under 30 to undergo the pap. I am not certain why, since the studies came out even for younger age groups too.)
Barb
Im with you Kim.
Tracie
If you think a pap is a violation of your sacred parts, just imagine was a violation cervical cancer would cause! Oh I should know, I had cervical cancer even though I went to get paps every year. Thank god I did or I would be dead! The cervical cancer treatment starts with many exams, biopsies and swabs of your cervix and only gets worse the worse it is. Best case scenario, you get a hysterectomy and don't even have a cervix anymore. But for many of us, it's a lot more invasive. I have been probed, hooked up to devices that gave me radiation right into my cervix and uterus, while several doctors stood around and all eyes between my legs. How would that feel? 5 days a week for 3 months, I had to get radiation to my pelvis and chest which meant lying flat, completely exposed, while the radiation therapists watched from behind a window as they delivered the lifesaving radiation beams. I had to get pelvic exams a minimum of every 5 days to check progress and make sure I wasn't burning too bad.. I did anyways though. Now that I am a 5 year survivor, I have to get a pap and pelvic every 3 months, for life. I've already had dysplastic cells recur 5 times and and had to go in for conizations to remove them before they can become cancer.
Liz
This is why I'm not so much into getting another one anytime soon. There is no friendly procedure, even for an autistic and person who has been abused. I get beef from people who say the pap tests have saved their lives, but I really feel like it's different for everyone.
What's more, other countries (e.g. the UK and Australia) have it available, but don't necessarily require it/make it as much of a priority.
...and, as an asexual who is completely turned off by the idea of personally being pregnant, I'm not too worried about exams being able to catch any infertility signs.
Kleigh
I agree. It's barbaric.
Lori
Agree 100%
AmericanTruth
Wow! Well said!
Dino
Ditto! Agree, well said.
merle
I am curious what you think ----
I had a pap last year, it came back with low-grade squamous cells, but I was pregnant so the mid-wife said we should wait until I give birth - it could go away on its own from the birth. I ended up miscarrying. Now, a year later, pregnant again - they did another pap and I got the same results. Only this time (different midwife group) they want to do a colposcopy -- while I'm pregnant.
So confused if I should just wait until after the birth or if I should go ahead with the colposcopy??
ashley
DEFINITELY wait. especially with your previous miscarriage. leave your cervix be for now. i had an abnormal pap when i was only 17 and was advised after an abnormal colposcopy to have a cone biopsy done. that turned out to be all normal. after that i don't really give it much thought. about every 3 years i have an abnormal pap. i won't let them do another colposcopy. i think its just my body's cycle.
tina
Doing the scope is looking at the cervix with a magnifying lens after painting the cervix with mild acetic acid (vinegar) abnormal cells turn white. This is done to see how wide the lesion is and how much of the cervix it covers. Normally they then take a "pinch biopsy" of the white area. That is the tricky part. Many women have it done and are fine, some miscarry. That is a problem for you. Squamous cancer of the cervix is normally slow growing cancer but you may now have had it for at least 2 years possibly longer if you had not had a PAP too often. You probably should see a OB that treats patients with abnormalities, they would have a better idea of the statistics or your case to make an informed decision.
Christi K
Great article, but what is the reasoning why we shouldn't have them done annually? Is it bad for us in some way? i just like LOTS of info from both sides 🙂
PS Love your blog!
tina
It is annoying, and can give a false positive (any test can and it is not all that common considering the millions done). A woman that has not ever had a positive pap and is in a stable sexual relationship or no sexual relationship could go ever other or even every three years. But remember they are testing for cancer ( but take a good look for other nastiest such as small lumps and STD's) . Over 20,000 women are DX'ed with cervical cancer each year in the US yet the death rate is very low as it is now caught very early and treated. Their is a large drop in the death rate in all countries that have added PAP testing to their public health program.
YP
Best thing I've ever done is listen to a woman who was in her 70's, she told me that if I wanted to keep my female "parts" intact and healthy I should stir clear of obgyns all together. She also gave me recommendations on a couple of books to read. Never stepping foot in an OBGYNs office ever again. I'll pass this knowledge to my daughter and grand daughters someday.
K
I would love to know which books! I definitely agree here. I’ve only had negative experiences with them.
Jessica
I get one every year and will continue to do so. At 21 an abnormal pap came back with stage 4 precancerous cells. They caught it before it was full blown cervical cancer. I had a LEEP performed where all abnormal cells were removed. Quite possibly that pap saved my life. I, from my experience, do not see the minor inconvenience of a pap as a problem as compared to cancer. And I was a healthy active (not Sexually active) college student.
Yaz
When are pap tests required? Do they have to be done before one becomes sexual active? I have never had relations so I assume it is not necessary plus do not want to have to go through such an invasive exam that can do damage..
annemarie
Interesting and empowering information....I would caution though, a friend did not have a pap for 4 years and was then found to have cervical cancer. She felt something was wrong and went to the doctor and lived to tell the tale. So if you feel you need to be checked, its a good idea.
Jane
Sorry for you friend. Do you know if she developed this because she had HPV which is the leading cause of cervical cancer? I'd imagine the first think they would have tested for is HPV once they found it as it will be recurring once she recovers.
chastity
Just went an new recommendation is even 5 years for "normal"...
mary
At 27 I was diagnosed with stage 1B cervical cancer...I was low risk, never had an abnormal pap. Had I followed these new guidelines I'd be dead because of how quickly the cancer progressed. The old guidelines saved my life and since it was caught before it spread, I was able to just have my cervix removed, not a hysterectomy, thus preserving my fertility.
Christy
I'm almost 34 and have never had a negative pap, so it is for that exact reason that I will continue to ask for them every year - I want to know if it changes. I go to the same midwives and birthing center where my 2 children were born. Since they have seen me giving birth naked in their tub, I never feel awkward or violated in any way. They are warm and genuinely caring, like family, and will take as much time as needed to answer all my questions or concerns (about anything in life, really). It's situational, but I have no qualms about getting a yearly pap 🙂
vicky
Why take a chance. I would ccontinue with whatever is recommened. It is more inconvenient to be diagnosed postive too late than have a false positive investigated. ..and i think I owe that little bit of inconvenience to my family.
Julie
My city in Canada has been recommending less pap tests for about 5 years now.
Marta
Well, i dont see a problem in doing it every year. I dont understand why so many women make such a big deal when they need to see a GYN. I personally have it covered entirely by my insurance and I will continue doing PAP each year.
Lainie
I am interested to know if you were paid by the pharmaceutical company behind Gardisil. Before the very big push for Gardisil the requirement was a yearly PAP screening. PAPs are not harmful to women other than the slight discomfort of having one. In the US only about 2% of women get cervical cancer and this has been attributed to the annual PAP smear.
So I wonder now why there has been a change? We know that PAP smears are a highly effective tool against cervical cancer. Why not employ both the PAP and the vaccine?
I have no problem getting an annual PAP and think the notion of "over-testing" is ridiculous. If getting a yearly flu shot is considered a standard then why not a PAP smear? A PAP smear could save your life and its an hour out your day. I'm really surprised that women are not fighting for this life saving test.
I think that what we will see now is an uptick in women who get cervical cancer as a result of less screening.. I'm sorry to say that when these numbers go up then we will also see a stronger push for Gardisil to save us. The benefit of the yearly PAP smear will be diminished as younger women will not know the value since they don't have it yearly.
Kim
1. Why would a major pharmaceutical company pay a blogger?
2. PAP tests were never "required". No one has the authority to tell a woman she has to get one.
2. Discomfort is harm. A woman should be made uncomfortable by strangers placing instruments into her vagina. The fact that we have become desensitized to this indicates a problem with how we view our bodies. Also, the post mentions the risks associated with further invasive testing following false positive results.
3. "Why not employ both the PAP and vaccine?" The vaccine should never be employed. It is a vaccine against the sexually-transmitted HPV. It is given to young girls, essentially giving them "permission" to engage in risky sexual activity. Most cancer is caused by HPV, and if young women were taught to abstain from sexual activity until marriage, when they would be monogamous for life, the Gardasil vaccine would be useless and constant PAP testing would be unnecessary.
4. A yearly flu shot is not "standard". I have worked in early childhood education for eight years and have never had a flu shot.
5. Young women don't need to know the "value" of a PAP test. They need to know the value of honoring their bodies. If young women were taught to honor their bodies, vaccinating for HPV and testing for cervical cancer would be completely unnecessary until a women perhaps decided, later in life, that she wanted to be tested.
Owlgirl
Great answer....keep legs closed till marriage or managamus relationship....make sure your husband to be is tested before marriage. .HPV can be carried by a man too.
B
You can honor YOUR body all you want, you can't guarantee others do the same. You can't guarantee others' monogomy.
Jemma
I stopped reading at it takes 10-20 years to develop, that is not true, so now I call into question the validility of the articles information. My mum got cervix cancer at 26, so bad that she needed a hysterectomy, she got tested the 2 years prior and there she was fine, it is slower than most cancers but it's still individual and it certainly can be a lot quicker that 10-20 years. My mum is living proof that two years is possible, if she had of left it another year or two, she wouldn't be here today.
Tracie
I couldn't disagree more! I am sickened by the new 3 year guidelines! I am a stage 2B2 cervical cancer survivor and I am now 33. It's been 5 years- I was diagnosed at 27! Not all cervical cancer take years to develop. I went to the doctor for a pap every year and my last pap was normal, ONE year before I was diagnosed with cancer! It's called adensquamous carcinoma and it's becoming more prevalent in the past 10 years, and it HIDES from pap tests until it's pretty advanced because the cells in this type of cancer are higher up in the cervix! I did not have symptoms and I just went for the annual pap and that's where it was found! I would be DEAD probably about 4 years ago now, if I didn't go ahead and get the pap. Lucky for me, planned parenthood required that I have a pap every year to keep getting birth control pills. Otherwise, I probably wouldn't have gone for that checkup. Also, planned parenthood offers pap testing for a extremely inexpensive price. I believe I paid $30! I did not have health insurance at the time. Planned parenthood is also part of a network where if you are lower income, laid off from your job etc, you will automatically be enrolled in a program where if you are ever diagnosed with breast or cervical cancer and uninsured, medicaid will kick in until you are cured! That is what happened to me and I am beyond thankful. It saved my life! Not getting a pap because you are embarrassed or feel violated is a very stupid reason not to get one! These doctors are not there to violate you! They're only trying to make sure you are healthy and possibly save your life! Now for me, I have permanent damage from this cancer and I narrowly escaped with my life. All of the things people my age are doing like starting families are things I can't do the "normal" way anymore. It will haunt me forever. Don't be stupid. Go get your pap!
Kim
Judging by your choice of medical practitioners, you understand very little about the sanctity of human life and of the female reproductive organs as the mysterious place where God forms that life. I would rather trust God to be the only examiner and guard of my sexual organs until the day I die than allow a murderer the chance to claim that they "saved my life". If you believe anyone at Planned Parenthood helps women more than they hurt them, we have nothing to further to discuss.
B
You're ridiculous.Leave god to guide people than, and stop giving your crazy advice.
Jeniene Glass
I was 17 when I had my 1st pap smear and 19 when I had my 2nd. They had been trying to track me down for two yrs because I had pre-cancerous changes that were congenital. Follow your heart but I am so thankful that we are advised to have them every year!
Trace
Don't you realize this is the opportunity to change the stats on cervical cancer - they are suggesting that testing less will lead to less false positives but really testing less will lead to less positives overall and then a few years from now when we all forget about this guideline change (or are nolonger here to care) there will be a tremendous spike in cervical cancer and guess what they will recommend even more than now - HPV vaccination. Yep this is all a ploy to take a cancer that is nolonger a top threat and make it a big threat so they can sell vaccinations!! Gardisal vaccines!!
F.M.
While I agree that less invasive testing is advisable for those with lower risk factors in most cases, I DO NOT agree with this change. Here's why:
I am 37 years old. I don't have high risk factors. I have had clear annual paps since I was 18, but this January my pap came back with abnormal cells. I had follow up biopsy which indicated precancerous cells and I had cryosurgery. My 3rd baby was born in Aug. My background suggests no high risks at all (I've never had HPV show up prior, I'm not high risk for std's or sti's, there is no family history, etc), had I not had the pap 1 year after my third pregnancy, I would have had a later stage of cancer necessitating a more invasive procedure and / or cervical removal. In discussing my options with my OB/GYN & the trends she has seen in her practice & in the scientific literature, it is evident that more precancers are being caught with the annual pap and that is why full blown cervical cancers are being seen less & less. While uncomfortable, I agree with my doctor, it is better to have the test yearly, catching suspicious cell activity early, and having a minimal procedure that will not affect fertility versus waiting 3-5 years and missing cells that are off and then finding out there is cancer which will lead to removal of parts of the reproductive organ or worse, malignant cancer. I say this also as a survivor of skin cancer and the daughter of parents who have passed away from breast and lung cancers.
chelsea
I am happy to say that my doctor told me testing every three years is what she recommends. She did mention that if I am switching sexual partners it can increase the risk of cell mutation or something ? (this was a while ago) and I should think about going every year and a half.
Sandra
My sister died of ovarian cancer. I know the pap smear doesn't test for ovarian cancer but if she had gone in for a yearly maybe her doctor could have felt her tumors during the part they poke around on your stomach. Or maybe she would have asked her doctor what is abnormal about the poly cystic ovarian syndrome she had. I wish she had gone. But now it's to late.
Wandy
I don't agree with this article. I was detected the Papiloma virus because I get check every year. Then I underwent cryo therapy. It Was cure. But imagine If I had that virus for three years undetected?
BlackBetty
Probably nothing would have happened to you. This is an unfortunate by product of pap testing, they terrify women thinking they may get cancer when cervical cancer is actually very rare.
Less than 30% of abnormalities or pre-cancer actually progresses but many women undergo invasive treatment anyway. They need balanced information on benefits, risks and overtreatment.
Des
I completely disagree. Pap smears not only do a poor job actually detecting cervical cancer, it's not even the best method to detect it. Nor is feeling inside a woman to detect problems. Blood tests for cancer and ultrasounds for tumors in the uterus and such is much better. Pelvic exams are next to unnecessary, and it's one of those things one has to research outside of their doctors.
Ersie
the Pap test was created bu a fellow Greek called Papanicolaou and has medium accuracy. Ask your doctor about newer DNA tests with 995% accuracy done every 5 years and addressing the virus responsible!
Lauren
Of course they don't tell patients about the new recommendations. They'll never give up that cash cow. Pap smears,are incredibly easy money. And the high level of false positives bring in even more easy money. I'm 36, haven't had a pap in almost 17 years. I refuse to get invasive testing for a rare cancer. Makes no sense. Especially with the total disregard the medical establishment has for physical problems in females. Drug side effects and auto immune diseases are WAY more common than cervical cancer but are routinely blown off.