Taking the Pap Test:
When, How Often, Why?
For millions of American women, their annual Pap test is a routine part of life. Each year they dutifully report to their doctor for pelvic, breast and Pap exams. These tests screen for infection, suspicious cell growth and cancers.
Earlier this year the American College of Obstetricians and Gynecologists (ACOG) revised the guidelines for the frequency of one part of these examinations—the Pap. While ACOG still recommends women visit their doctor annually, women age 30 and older may only need a Pap every two or three years. However, women under the age of 30 and women with previous abnormal Pap results should continue to have the annual test.
“Even if a woman decides against a yearly Pap, she should still have annual exams including a breast and pelvic exam, blood pressure and weight check. The gynecologic exam can help protect bladder and sexual functioning as well,” says Karen Roberts, MD, Drs. May-Grant Associates.
A woman should start annual gynecologic examinations when she becomes sexually active or when she reaches 18 years of age—whichever occurs first. She should get her first Pap three years after her first sexual experience or by the age of 21.
Most of the time, gynecologic exams and Pap tests come back as normal and don’t require follow-up. However, 250,000-1 million women—most between the ages of 25-35—have irregular Pap results each year.
For nearly 70 percent of these women, atypical results indicate ASCUS (atypical squamous cells of undetermined significance). These cells don’t look quite normal, are often caused by a temporary infection and are not something to worry about, says Charles Castle, MD, OB-GYN Associates of Lancaster. Dr. Castle explains that women with ASCUS usually do not need treatment because the atypical cell growth may go away on its own.
Other times, a sexually transmitted virus called HPV (human papillomavirus) may cause abnormal cell growth, which can lead to a precancerous or premalignant condition known as dysplasia. Doctors often order an HPV test to help them in their diagnosis and treatment plan. The National Cancer Institute even recommends HPV testing with ASCUS results—just to rule out dysplasia.
“HPV can help distinguish truly abnormal Paps from false alarms. The presence of HPV alerts the provider that a patient requires closer evaluation—usually a colposcopy,” says Dr. Roberts. During a colposcopy, your doctor will examine the vagina and cervix more closely and will send tissue samples to the lab for analysis.
When the colposcopy results indicate moderate or severe dysplasia, your doctor may recommend removal of these cells by:
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LEEP (loop electrosurgical excision procedure) – removing abnormal cells using an electrically charged, thin wire loop
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Cryotherapy – freezing and killing abnormal cells
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Laser therapy – destroying abnormal cells with lasers
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Conization – surgically removing cone-shaped section of abnormal tissue
“If a woman does the right thing and gets her tests on a regular schedule, she’ll be fine,” says Dr. Castle. “Unlike some other more aggressive cancers, cervical cancer is a very slow-growing disease. With the proper follow-up and care, it is easy to identify and treat before it turns into invasive cancer.”
For more information about women’s health, talk with your doctor or gynecologist or stop by the Women’s Wellness Center at the Lancaster General Women & Babies Hospital. If you don’t have a doctor, use our “
Find a Doctor” feature or call 1-800-314-2121.