PAP smear Guidelines

The New Recommendations for PAP smears
from The American College of Obstetricians and Gynecologists (ACOG) and the US Preventative Task Force (USPTF)

In March 2012, the U.S. Preventive Services Task Force (USPSTF) announced new recommendations for Pap smear screening for cervical cancer. ACOG then came out with their recommendations. Does this mean the end of the yearly exam for patients _Definitely not!

Although many women come into the office for their Pap smear, there is much more to the visit than the annual Pap test. Checking on things such as height, weight, BMI, blood pressure, physical exam and lab work are also an important part of the visit. Other preventive screenings such as osteoporosis, cholesterol, hormone levels and there are many different new tests that are available to test for vitamin levels, genetic risks and heavy metals (see the list on Our practice is about wellness and optimal health, not just about prevention. If you have any questions or concerns about these changes we can tailor a program specifically for you.

In addition if you are taking any medication that requires us to give you a prescription, you will be asked to make an annual visit. This may involve an exam and lab tests, unless you are having your exams with another physician.

The New Recommendations

Women should have their first screening Pap smear at age 21 unless they have already had a previous abnormal Pap smear. If you are younger than 21 and not sexually active there is no need for screening. If you are younger than 21, sexually active and have had more than one partner, you may acquire HPV, however the chances of having cancer are very low.

If you have already had an abnormal Pap test or are positive to HPV, you should be screened annually or more often depending upon your other risk factors.

Women in their 20’s should have a Pap smear every two years (assuming prior Pap smears have been normal) according to ACOG. The USPTF recommends every 3 years.

Women age 30 and older who have had three consecutive normal Pap smears should have a Pap smear every three years.

Women age 30 – 65 may also choose a Pap smear screening with HPV testing every 5 years

Women who have had a hysterectomy for non-cancerous reasons do not need a Pap smear unless they have a cervix or unless they have had a history of HPV or a new sexual partner. We have seen a few cases of dysplasia along the scar line so I would still recommend doing Pap smears if risk factors are present

These guidelines need to be followed whether you have or have not had the HPV vaccine

We still recommend a yearly physical including a breast exam, pelvic exam and sexual transmitted disease screening if indicated. A pelvic exam may be done without needing to do a Pap smear based upon your history or complaints. Vaginal discomfort, itching should be reported as well as any complaints of lower abdominal pain, fullness or urinary symptoms. You may also have an exam of the external genitalia to assess any lesions that you may be feeling.

You must have an annual exam to receive birth control, hormones or any other prescription that you need. Since you will not be receiving reminder cards for Pap smear, we will be instituting a reminder system for patients needing prescription renewal. Because most of our patients are on email, we will be changing to email reminders requiring you to respond back that you have received it.

Why the Guidelines Have Changed

The role of the USPSTF is to review screening methods for effectiveness in preventing disease and also avoiding unnecessary procedures that cause negative effects. This was the same rationale for the changes in mammogram screening that occurred last year.

This recommendation updates the 2003 USPSTF recommendation on screening for cervical cancer. It differs from the previous recommendation in that it recommends cytology screening every 3 years among women age 21 to 65 years. In addition, this recommendation includes more guidance on the appropriate age ranges and frequency of screening, including a new recommendation that women younger than age 21 years not be screened because the evidence shows no net benefit. The previous recommendation suggested that most of the benefit of screening could be obtained by beginning screening within 3 years of onset of sexual activity or age 21 years (whichever comes first) and screening at least every 3 years thereafter.

The USPSTF recommends against screening for cervical cancer in women older than age 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer (those with a history of cervical dysplasia, HPV infection or multiple sexual partners)

The USPSTF recommends against screening for cervical cancer with HPV testing, alone or in combination with cytology, in women younger than age 30 years. In other words, HPV testing in everyone is not necessary.

The USPSTF recommends screening for cervical cancer in women age 21 to 65 years with cytology (Pap smear) every 3 years or, for women age 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and human papilloma virus (HPV) testing every 5 years. ACOG recommends screening for women in their 20’s every two years.

The USPSTF recommends against screening for cervical cancer in women older than age 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer.

The ACS/ASCCP/ASCP guidelines define adequate prior screening as 3 consecutive negative cytology results or 2 consecutive negative HPV results within 10 years before cessation of screening, with the most recent test occurring within 5 years. They further state that routine screening should continue for at least 20 years after spontaneous regression or appropriate management of a high-grade precancerous lesion, even if this extends screening past age 65 years. The ACS further states that screening should not resume after cessation in women older than age 65 years, even if a woman reports having a new sexual partner.

The USPSTF recommends against screening for cervical cancer in women who have had a hysterectomy with removal of the cervix and who do not have a history of a high-grade precancerous lesion (cervical intraepithelial neoplasia [CIN] grade 2 or 3) or cervical cancer.

What We Are Recommending

We are happy to discuss these guidelines at your annual visit and decide what is best for you. Under certain circumstances, screening may be recommended more often for a variety of reasons, such as exposure to a sexually transmitted disease or a concern for possible infection. For established patients we recommend that you come in for blood tests around 7-10 days before your visit whenever possible. We will have those results and can also discuss them at your visit. If you have lab tests done by another physician, please arrange to have those tests sent to us.

We are committed to providing you with high quality service supporting you in optimal health. Please feel free to discuss any questions concerns that you have about these changes at your appointment. We can tailor a program of screening specifically for you.