New pap test does not eliminate need for exams

Don’t let new recommendations for cervical cancer screenings confuse you; women still need a gynecological exam each year. The revised guidelines reduce the number of Pap tests a woman receives in her lifetime, but a Pap test (which screens for cervical cancer) is just one small part of the exam.

During a gynecological exam, your caregiver checks your reproductive health by asking questions and examining your breasts and pelvic area. This visual and manual check of your breasts, vulva, cervix, vagina, uterus, ovaries and rectum helps your caregiver find abnormalities, masses or growths that could be a problem. There is no screening test for ovarian or uterine cancer, so the physical assessment is important to detect these and other conditions that could impact your reproductive and overall health.

Years ago, cervical cancer was the leading cause of cancer death in women. With advances in treatments and screenings, such as the Pap test and the test for the human papillomavirus (the primary cause of cervical cancer), it is rare for women to die from cervical cancer today.

In March 2012, after reviewing scientific evidence about the benefits and harms of the Pap test, two separate organizations, the United States Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS,) recommended lengthening the number of years between Pap tests from one to three for women over age 21.

They also introduced an option of a five-year screening interval for women ages 30-65 when screened with a combination of Pap testing and human papillomavirus (hPV) testing. This is because hPV progresses to cervical cancer slowly, sometimes taking up to 10 years. With a screening every three years, five if a woman is negative for hPV, there is ample time for early detection. More frequent screenings increase the chance for false positives, unnecessary tests and biopsies.

The USPSTF and the ACS also recommend against Pap tests for women before age 21 and after age 65. Studies showed many precancerous changes in women under age 21 correct themselves and that surgical treatments in these young patients can lead to fertility problems.

Since many women associate the Pap test with their annual gynecological exam, some are now making the mistake of completely skipping the exam. Here’s what you need to know:

All sexually active women, women with symptoms such as pelvic pain, abnormal discharge or menstrual disorders, and women over the age of 21, should have a gynecological exam at least annually.

Women under age 21 should NOT have a Pap test as part of their gynecological exam.

Women ages 21 to 30 should have a Pap test every three years.

Women ages 30 and up should have a Pap test every three years, but combining the hPV and Pap test every three to five years is preferred.

The Pap test is not recommended for women age 65 or over with three or more normal Pap tests in a row and no abnormal Pap test results in the past 10 years, or who had two or more negative hPV tests in the past 10 years.

If you are unsure whether you are due for a Pap test, hPV test or a gynecological examination, consult your caregiver’s office for guidance.

Dr. Charles Lamade of Susquehanna Health OB/GYN is a graduate of the University of Pittsburgh School of Medicine and completed his residency at Aultman/Timken/Mercy Hospital. He is board certified in obstetrics and gynecology.