Should women get an annual Pap smear test? January was Cervical Health Awareness Month and as we pass into February, we want to try to make sense of the current guidelines on when women should have a Pap smear test.

A study published in September 2009 Journal of Obstetrics and Gynecology suggested some women can wait three years in between Pap smear tests. For years, women have been told to get an annual Pap smear test. So these new recommendations are welcome to some, anxiety-provoking to a few and confusing to many.

So here is an attempt to sort out some of the confusion. The most common cause of cervical cancer is the Human Papilloma Virus (HPV). This virus is exceedingly common. Only a few strains of the virus are actually harmful, a few cause cervical cancers (and pre-cancers) and a few strains cause genital warts.

Although many women will be exposed to the virus in their lifetimes, only some will actually go on to develop pre-cancers and cancer. A woman might develop cancer without any symptoms, so the advent of Pap smear tests was a milestone in preventative medicine, and it has saved thousands of lives.

Another important milestone occurred in 2006 when a vaccine for HPV called Gardasil came on the market. Girls and women aged 9-26 are eligible for the vaccine, which protects against the four most dangerous strains of HPV. A cancer vaccine is a great advance, and I urge all parents and young women to discuss the vaccine with their doctors. However, don’t become complacent if you receive the vaccine. Gardasil doesn’t prevent against every strain of HPV, and there are rarer subtypes that can still cause cervical cancer, so Pap smear tests are still important.

When should you start? Young women should start getting screened three years after the initiation of sexual activity, or at age 21, whichever comes first. Simple enough, but when do you get your next Pap smear test? And do you keep getting it every year forever?

There is actually no simple, one-size-fits-all answer. Some women who have had abnormal testing actually need to do Pap smear test every six months. Other women who’ve always had normal Pap smears and HPV tests can space their Pap smear tests out to every 3 years. And not all Pap smear tests are created equally—some come with HPV testing, some without. So how do you know when to go back?

Luckily, you don’t have to figure this out by yourself. Here are some guidelines:

1. Keep getting your annual physical. You and your doctor can figure out how often you’re due for a Pap smear test. Even if you don’t need the Pap smear test, you may still need other testing, so the visit won’t be wasted. You might not need a Pap smear test, but you may need a breast exam, mammogram, pelvic exam (where the doctor feels for masses or enlargement in the ovaries or uterus), cholesterol testing or diabetes screen, depending on your age and risk factors.

2. Ask for copies of your test results. It’s always important to keep your own records in case of a move or change of providers. The most reliable way for a new physician to determine follow up care is to see your records and having them in your possession can save delays and unnecessary testing.

3. Don’t let your insurance status stand in your way. In this economy, in southeast Michigan, plenty of people have lost their insurance or never had good insurance to begin with. There are resources in our area: take advantage of them
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• Title XV, or the Breast and Cervical Cancer Control Program, covers breast and cervical cancer screenings for women aged 40-64 whose income is at or below 250% of the federal poverty level. Call 800-922-MAMM for more information.


• Plan First covers family planning services, including Pap smear tests, for women aged 19-44 who are at or below 185% of the federal poverty level. Call 800-642-3195 for more information.


• Or for further details on both those plans, or for more options, check out http://www.michigan.gov/mdch/

This article on cervical health was written by one of the physicians on the Packard Health staff with Dr. Rion, Jean Wong M.D. Dr. Wong graduated from the University of Michigan Medical School in 2004 and completed her residency and an academic fellowship at the University of Michigan's Family Practice department, where she was chief resident. Her clinical interests include women's health and children's health. Dr. Wong recently published an article, “Update on ASCCP Consensus Guidelines for Abnormal Cervical Screening Tests and Cervical Histology,” Barbara S. Apgar, MD, MS; Anne L. Kittendorf, MD; Catherine M. Bettcher, MD; Jean Wong, MD; and Amanda J. Kaufman, MD, Am. Fam. Physician. 2009; 80(2):147-155.