Guest Author - Denise Howard, M.D., M.P.H.

Who should have a pap smear? Should I be screened for Human PapillomaVirus (HPV)? Is it necessary to have a Pap every year? These are common questions that many women have. Recommendations for cervical cancer screening are typically provided by organizations that have an interest in women’s health or cancer prevention. Such organizations include the American College of Obstetricians and Gynecoogist, the American Cancer Society and the US Preventive Services Task Force. The recommendations are based on factors that increase an individual’s chance of being exposed to human papilloma virus and factors that make them more susceptible to persistent infection.

The peak age for HPV infection occurs between 15-25 years of age and again in the 6th decade of life. The incidence of cervical cancer appears to peak in the 3rd and 6th decade of life. Women, who smoke, have multiple sexual partners and who have disorders that suppress their immune system are more susceptible to persistent HPV infection and subsequent cervical cancer development.

The following are commonly asked questions. The answers are provided.

Who should have a pap test? Every woman who is sexually active.

When should a girl start having a pap test? 3 years after the first sexual encounter or by age 21.

How frequently should a pap be done? Every year until age 30 and then every 2-3 years if you have had a series of 3 normal Pap tests. If HPV testing is negative then every 2-3 years is acceptable.

Can a woman ever stop having a Pap test? The recommendations vary. Some say no and others suggest by age 70 if all Paps in the past 10 years are normal. Also if there are no risk factors.

What about cases of hysterectomy? If a woman has a history of cervical dysplasia she should have 3 consecutive negative Paps over a 10 year period then she can stop screening. If there isn’t a history of cervical dysplasia then all of the organizations state that screening is not necessary.

The final question that typically arises relates to prevention. Is there anything that can be done to prevent cervical cancer and HPV infection? The answer is yes. Those things include limiting sexual partners, using condoms, staying healthy so your body is able to fight infections, stop smoking, utilize the effective screening programs already established, i.e., the Pap test and consider taking advanatage of the newly available HPV vaccination. Prevention is always the ideal strategy.