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My Pet Peeve with Pap Smears


Let me rephrase that! I have nothing against the pap smear test (it has significantly helped with early detection and treatment of cervical cancer, decreasing mortality and complications) but I have everything against performing the test on patients who don't need it! For as long as I have been practicing (it isn't that long - 2 years) I already find myself frustrated with the amount of times a patient has come to me thinking they are due for a pap smear when they had a normal pap smear completed last year or when the patient is only 16 years old.


As a female and as a physician I can say without hesitation no woman is eager to getting their pap smear done. So why are so many patients taught to believe that they need this test yearly? It frustrates me to hear patients state "I've always had yearly pap smears because that's what my past doctor has always done." When asked if they have had an abnormal pap the answer is usually no and when reviewing patient's medical record I usually don't see an indication for yearly paps. An even bigger misconception is requiring a pap smear prior to starting an oral birth control. This is absolutely not recommended. You don't need to have a pap smear in order to start oral birth control, unless you are due for a one.


Past guidelines did recommend pap smears to begin before 21 years of age if patient was sexually active and yearly screenings but that has not been the case for quite a few years now. So let's review the current guidelines on pap smears: The USPSTF recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years, whether she is sexually active or not. Pap smears can be done every 3 years if the last pap was normal. For women aged 30 to 65 years, the USPSTF recommends screening every 3 years with cervical cytology alone, every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting).This changes if you have a history of an abnormal pap or HPV result. Always follow up with your doctor's recommendations.


Note: The American Cancer Society (ACS) has updated it's new guidelines back in July; for people aged 25 to 65 years, the preferred screening recommendation is to get a primary HPV test every 5 years.


This is post is for educational purposes only and to raise awareness to an issue I've commonly seen as a physician. The bottom line is, ask your doctor to explain to you the latest guidelines! If you are unsure, you can look it up. The best resource I recommend is USPSTF (United States Preventative Task Force). This may differ from let's say ACOG (The American College of Obstetrics and Gynecology) so it is best to talk to your provider.


USPSTF, ACS and ACOG may differ in their guidelines and your provider will decide which guidelines to follow. But in my humble opinion, in general providers should be familiar and up to date with all guidelines and adjust their practice based on their clinical judgement and experience.


Many patients are relieved knowing they don't need one for some time. This increases patient satisfaction, provides better care and evidence based practice that all physicians should strife for in their practice.


Disclaimer: I do not provide direct medical advice, diagnosis, or treatment through this website. Any information published on this website is not intended as a substitute for medical advice from your personal doctor, and you should not take any action before consulting with your personal doctor.

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