How often do I need a pap smear?

by Dr. Nadine Antonelli

Posted on November 7, 2014

Wilmington, NC

A common question I hear during a woman’s yearly exam is, “Do I really need to have a Pap smear every year?”

The quick answer is probably not, but maybe you should.  The only way for your physician to answer this question with certainty is to know your history.    You can read many conflicting and confusing recommendations if you go on-line and try to answer this question for yourself.  This is because Pap smear screening recommendations are constantly changing, especially in recent years due to availability of sensitive assays for the detection of high-risk HPV virus, which is a risk factor for the development of cervical cancer.  Although HPV testing is available, it is not recommended that HPV testing be done routinely on all women. 

Simply put, there is not a “one-size-fits-all” answer.  A patient’s age, sexual history, medical history, reproductive history, and history of previous cervical issues all determine the frequency and type of cervical screening, with or without HPV testing, that is performed.   In low-risk patients, there is often more than one acceptable way to screen for cervical cancer.  A patient’s preference often determines whether or not a pap smear is performed at a particular visit.  Currently, most private insurers still pay for yearly Pap smear testing in reproductive aged women.  In my clinical experience, most women request yearly Pap smear testing with their annual exams if a choice is given.

It is important to understand that a pelvic exam, an exam to evaluate a woman’s reproductive system, does not necessarily include a Pap smear test.  A Pap smear is a specific screen that is sometimes obtained during a pelvic exam to screen for precancerous or cancerous lesions.  The goal of universal Pap smear screening is to identify women who may be at risk of developing cervical cancer in order to effect treatment to prevent that cancer.   In rare cases, especially when women have gone several years between screenings or have a previous history of precancerous lesions that were inadequately treated, it may detect cancer. 

Fortunately, cervical cancer does not develop overnight.  With regular visits to your physician, periodic Pap smears and reducing risk through healthy sexual practices and avoidance of smoking, your risk of developing cervical cancer is extremely low. 

Nadine Antonelli, MD

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