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Why Annual Pap Smears Are History – But Routine Ob-Gyn Visits Are Not

An ob-gyn explains current guidelines for cervical cancer screening and routine checkups.

By Dr. David Mutch

In the recent past, women were advised to visit their ob-gyn every year for a Pap test, a pelvic exam, and a breast exam. The Pap test, also called a Pap smear, is a screening test for cervical cancer.

Fast forward to today, and our advice has changed. Women should still visit their ob-gyn each year, and I’ll outline why that’s so important below. But we no longer advise women to have an annual Pap test. A big reason for the change: We now better understand how cervical cancer develops over time—we know it takes many years to develop—so we’ve expanded the time between screenings.

We also now have two screening options to detect cervical cancer, the Pap test, and the HPV test. (HPV stands for human papillomavirus—a virus that can cause cervical cancer.) With both tests, cells are taken from the cervix and tested. The Pap test looks for abnormal cells that may develop into cancerous cells over time. The HPV test looks for the strains of HPV that are most likely to cause cancer.

Here’s a quick summary of ACOG guidelines for cervical cancer screening:

• Women aged 21 to 29 should have a Pap test alone every three years. HPV testing alone can be considered for women 25 to 29, but Pap tests are preferred.
• Women aged 30 to 65 have three options for testing. They can have both a Pap test and an HPV test every five years. They can have a Pap test alone every three years. Or they can have HPV testing alone every five years.
• After age 65, you can stop having cervical cancer screenings if you have never had abnormal cervical cells or cervical cancer and you’ve had two or three negative screening tests in a row, depending on the type of test.

Exceptions to the guidelines

You may need more frequent screenings if you:

• have a history of cervical cancer
• are HIV positive
• have a weakened immune system,
• were exposed before birth to diethylstilbestrol (DES, a hormone given to pregnant women between 1940 and 1971)

If you have had a hysterectomy, you may still need screening. And if you’ve had the HPV vaccine, you should still follow the guidelines. The vaccine doesn’t protect you against every type of HPV.

Doctor’s notes

Most women are exposed to HPV during normal sexual activity if they’ve had more than one sexual partner. We don’t do Pap tests before age 21 because the likelihood of someone that young getting cervical cancer is very low. After age 65, the possibility of having an abnormal Pap test also is low.