Cervical Cancer Screening:

The PAP smear screening test for cervical cancer has been one of the most successful screening tests for women. It decreased the incidence of cervical cancer deaths by 70% over several decades. Over the last decade there have been many new advances in screening for cervical cancer and its precursors (dysplasia).

The traditional PAP smear is able to pick up 70-80% of abnormal smears. Several years ago we began using a new liquid based cytology “PAP” smear (Thinprep or Surepath). These tests have a higher sensitivity and are able to pick up more abnormal smears. But even these new techniques can miss up to 15-35% of abnormalities.

Human papilloma virus (HPV) is a sexually transmitted disease associated with genital warts and the development of cervical cancer. Several “high risk” HPV virus types have been identified as causing cervical cancer. Most HPV infections clear spontaneously especially in younger women. Younger women also appear to be at higher risk of developing infection in the first place. Women over 30 years old with HPV infection have a higher risk of developing dysplasia and/or cancer.

New studies on HPV testing in women over 30 years old with a liquid based PAP smear are even more sensitive in detecting cervical cancer or its precursors. If both tests are negative, it rules out 99-100% of advanced dysplasia or cancer. Because it is more sensitive it only needs to be done every 3 years as opposed to traditional cervical cancer screening. Certain high risk women (those with a history of advanced dyslasia or cervical cancer may still need yearly screening).

Those women with a positive high risk HPV test and a negative liquid based cytology test are at higher risk to develop cervical abnormalities and will need to be tested more frequently. Usually they would be screened yearly. If the HPV test is again positive, they would need a colposcopy to further evaluate the cervix. If the liquid based cytology is abnormal, they would be referred for follow up. Usually the follow up would involve colposcopy as well.

Please be aware that less frequent screening applies only the “PAP” smear and not to other screening tests or the annual exam. Most women should still undergo an annual breast and pelvic exam. Please discuss this with your provider if you have any questions.

PAP SMEAR SCREENING GUIDELINES:

Begin screening 3 years after beginning sexual activity or at age 21, whichever comes first.

<30 yo: Annual PAP until 3 negative PAP smears and then 2-3 years if low risk. Continue annual screening if high risk (i.e. history of dysplasia or Ca, multiple partners, DES exposure or immunocompromised).

>30 yo: PAP and HPV test every 3 years if both negative. If positive HPV and negative PAP, repeat both tests in 6-12 months. If still positive, undergo colposcopy. If abnormal PAP, manage accordingly.

If hysterectomy (cervix absent), no need for PAP unless history of cancer or dysplasia.

HPV can be used as a test of cure after excision/ablation of CIN II-III. It should be done at 6-12 months and if positive, refer for colposcopy.