Guidelines have changed so that most women do not need an annual Pap test. But that doesn’t mean they’re any less important, says Dr. Teela Sorensen, a gynecologist at Tanner Clinic Syracuse.
The Pap test looks for the human papillomavirus (HPV), among other abnormalities. As more is learned about this virus, experts have revised the guidelines to more efficiently prevent HPV, as well as the cervical cancer it causes, she said.
It’s seems to be working. In the 1930s, cervical cancer was the most deadly cancer among women. It killed more women than breast or lung cancer combined. Today, deaths from cervical cancer are at record lows. “We really shouldn’t have any cervical cancer today,” said Dr. Sorensen. With preventive measures, she adds, “It should be very rare.”
However, the human papillo- mavirus is the opposite of rare. In fact, HPV is the most commonly sexually transmitted infection in the U.S. “It seems to be ubiquitous in the community anymore,” said Dr. Sorensen. For instance, it’s estimated at 85 percent of college-aged people carry the virus.
New guidelines for Pap tests
The danger of this ubiquitous virus is that it can cause changes to the cells in the cervix, the area between the uterus and the vagina. Those altered cells are often precancerous and, if left untreated, can advance to invasive cervical cancer.
So, it may seem contrary to logic that the new guidelines, adopted in 2012, reduce the need for HPV testing.
That’s because, says Dr. Sorensen, those cervical changes often don’t show up for many years. If cell changes occur in women in their 20s, she adds, “They will clear up in most cases.”
Here are the new guidelines:
▸ Women aged 21 to 29: Pap test every three years. The new rules specifically recommend against annual Pap testing.
▸ Women age 30 to 64: Pap test every three years. If the Pap test is negative for HPV and abnormal cells, Pap tests can be conducted every five years.
▸ Woman age 65 and older: Screening is not recommended for those who have had three or more normal Pap tests in the past 10 years.
▸ Women who’ve had hysterectomies: No Pap test is required.
Women whose results are positive for HPV should repeat the exam and be tested to determine the specific strain of HPV.
If further testing reveals precancerous cells, a colposcopy biopsy is performed. Less often, a portion of the cervix will need to be removed. The LEEP procedure (Loop Electrosurgical Excision Procedure), as it’s called, uses a low-voltage electrified wire loop to excise the cells.
Gardisil prevents against HPV infection
With the advent of vaccinations such as Gardasil less than a decade ago, cervical cancer becomes the only cancer prevented by a vaccine. The vaccination blocks the four most common strains of HPV — these strains are also the ones that cause cervical cancer as well as genital warts.
The vaccination is recommended for adolescents and young teens with the goal of stopping the virus well before they become sexually active. However, any young woman up to 26 years old can receive the immunization. “It just doesn’t work as well in women who are older,” Dr. Sorensen said.
Unlike Pap tests, regular physicals still yearly
Pap tests may not be yearly milestones, but physical exams should continue to be conducted annually, said Dr. Sorensen. Women need breast and thyroid exams, she said. In addition to heart and lung checks, labs are taken for cholesterol, glucose, thyroid and blood health.
Plus, Dr. Sorensen always tests for hyper- or hypothyroidism — as well as cancer. “Since I’ve been here in Utah,” she said, “I’ve found thyroid cancer in four women just by feeling their neck and thyroid in an annual exam.”
Dr. Sorensen has a firm belief in the importance of annual exams because the majority of women she sees are running on empty, she said. Indeed, up to four in five of every patient in her practice complain of fatigue.
“Women are just tired. We cram too much into our lives,” she said. “It’s hard being a woman these days because we have such hectic lives.”
For those sleepy women, she adds, the annual visits can be a mood-lifter. “I’ve had babies. I’ve had a hysterectomy. I think I can relate pretty well to what women go through,” she said. “We laugh a lot. We laugh about husbands and kids and what we go through with them. We just have a pretty good time.”