Do You Really Need a Yearly Pap Smear?

If you’re a woman, a pap smear is a part of your life. It has become synonymous with a gyn exam (“I’m due for my pap,”) but the recommendations have changed, and research shows the majority of women no longer need this screening test every year. Insurance companies are denying coverage for the test, which leaves many of us wondering if we really don’t need one or if the cost is driving inadequate health care, leaving us undiagnosed.

Before the development of the pap test, cervical cancer was one of the most serious cancers affecting women. In third world countries, women continue to die in large numbers from this preventable disease. Over 90% of cervical cancer is caused by the human papilloma virus (HPV) which is common, affecting as many as 70% of sexually active women. HPV is largely asymptomatic, and obviously, based on these numbers, most women with HPV do not develop cervical cancer. When caught early (hence the success of the pap test in reducing incidence) cervical cancer is treatable.

The U.S. Preventative Services Task Force recommends:

no pap before the age of 21, as the majority of abnormalities in young women will resolve on their own
between the ages of 21 and 65, paps every 3 years as cervical cancer is a slow growing cancer. If women want to space out screening more, a pap plus a cytology test every 5 years
after the age of 65, if women have had adequate screening prior, and are not at high risk, no more paps

The recommendations of ACOG (American College of Obstetrics and Gynecology) are similar:

Women aged 21–29 years should have a Pap test alone every 3 years. HPV testing is not recommended.
Women aged 30–65 years should have a Pap test and an HPV test (co-testing) every 5 years (preferred). It also is acceptable to have a Pap test alone every 3 years.
After the age of 65, you can stop cervical cancer screening 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.

BUT, this does not mean you should stop seeing your gyn every year. They do more there than just your pap. Here is why you should have your annual gynecologist exam.

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