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Explanation of Pap Smears with Current Guidelines

 

What is a Pap Smear?
A Pap Smear is a test used to find changes in the cells of the cervix that could lead to cancer. The cervix is the opening to the uterus located at the top of the vagina. The Pap Smear includes cervical cytology  and if you meet criteria testing for the human papillomavirus (HPV).

A Pap Smear is simple and fast. You lie on an exam table and a speculum is used to open the vagina. The speculum gives a clear view of the cervix and upper vagina.
Cells are removed from the cervix with a light rubbing by a brush or other sampling instrument. The cells usually are put into a special liquid and sent to a laboratory for testing:
• For a Pap Smear, the sample is examined to see if abnormal cells are present.
• For an HPV test, the sample is tested for high-risk HPV types.


How often should I have a Pap Smear and/or HPV testing?
How often you should have cervical cancer screening and which tests you should have depend on your age, health history and even sometimes your insurance:
• Women aged 21–29 years should have a Pap test alone every 3 years. HPV testing is not recommended.
• Women aged 30–65 years, with no history of abnormal Pap Smears or high risk HPV, may have a Pap test and an HPV test no later than every 5 years, or a Pap Smear, without HPV testing, no later than every 3 years.


When should I stop having Pap Smears?
Medicare currently covers Pap Smears every 2 years, but if you want, you may stop having Pap Smears with your well woman exam after age 65 years if:
• you do not have a history of moderate or severe abnormal cervical cells or cervical cancer, and
• you have had either three negative Pap test results in a row or two negative co-test results in a row within the past 10 years, with the most recent test performed within the past 5 years.


If I have had a hysterectomy, do I still need Pap Smears?
If you have had a hysterectomy, you still may need screening. The decision is based on whether your cervix was removed, why the hysterectomy was needed, and whether you have a history of moderate or severe cervical cell changes or cervical
cancer. Even if your cervix is removed at the time of hysterectomy, cervical cells can still be present at the top of the vagina. If you have a history of cervical cancer or cervical cell changes, you should continue to have screening for 20 years after
the time of your surgery.


Are there exceptions to Pap Smear screening guidelines?
Yes. Women who have a history of cervical cancer, are infected with human immunodeficiency virus (HIV), have a weakened immune system, or who were exposed to diethylstilbestrol (DES) before birth may require more frequent screening and should not follow these routine guidelines. Having an HPV vaccination does not change screening recommendations. Women who have been vaccinated against HPV still need to follow the screening recommendations for their age group.


What does it mean if I have an abnormal Pap Smear?
Many women have abnormal Pap Smears and this does not mean that you have cancer. Remember that cervical cell changes often go back to normal on their own. If they do not, it often takes several years for even high-grade changes to become cancer. If you have an abnormal Pap Smear, additional testing is needed to find out whether high-grade changes or cancer actually are present. Sometimes, only repeat testing is needed. In other cases, a colposcopy and cervical biopsy may be recommended to find out how severe the changes really are. If results of follow-up tests indicate high-grade changes, you may need treatment to remove the abnormal cells. You will need follow-up testing after treatment and will need to get regular cervical cancer screening after the follow-up is complete.


How accurate are Pap Smear test results?
No lab test including cervical cancer screening can be 100% accurate. Sometimes, the results show abnormal cells when the cells are normal, this is called a “false-positive” result. Cervical cancer screening also may not detect abnormal cells when they are present, this is called a “false-negative” result. To help prevent false-negative or false-positive results, you should avoid douching, sexual intercourse, and using vaginal medications or hygiene products for 2 days before your test. You also should avoid Pap Smears when you have your menstrual period.

What causes cervical cancer?
Most cases of cervical cancer are caused by infection with high risk HPV. HPV is a virus that enters cells and can cause them to change. Some types of HPV have been linked to cervical cancer as well as cancer of the vulva, vagina, penis, anus, mouth,
and throat. Types of HPV that may cause cancer are known as “high-risk types.”
HPV is passed from person to person during sexual activity. It is very common, and most people who are sexually active will get an HPV infection in their lifetime. HPV infection often causes no symptoms. Most HPV infections go away on their
own. These short-term infections typically cause only mild (“low-grade”) changes in cervical cells. The cells go back to normal as the HPV infection clears. But in some women, HPV does not go away. If a high-risk type of HPV infection lasts
for a long time, it can cause more severe (“high-grade”) changes in cervical cells. High-grade changes are more worrisome as they could, over time, lead to cancer.


Why are Pap Smears important?
It usually takes 3–7 years for high-grade changes in cervical cells to become cancer. Cervical cancer screening may detect these changes before they become cancer. Women with low-grade changes can be tested more frequently to see if their
cells go back to normal. Women with high-grade changes can get treatment to have the cells removed.

 

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