Pap Smear Guidelines

Pap smear recommendations can be confusing for patients.  I can’t tell you how often a patient of mine asks me when her daughter should get her first pap smear.  And that is because things have changed so much through the years.  Recommendations in medicine are ever changing, especially as our technology improves.  Why?  Well, our ability to detect disease improves.  Plus, our knowledge of the disease state improves too.

Pap smears are actually a huge topic that I won’t be able to fully cover in one blog.  But I will get started here today.

The guidelines that we use are published by The American Society for Colposcopy and Cervical Pathology (ASCCP) and reinforced by The American Congress of Obstetricians and Gynecologists (ACOG).  The most recent guidelines were revised by ASCCP in 2012.

A pap smear is a gathering of cells from the cervix.  The purpose of a pap smear is to detect cervical cancer.  In fact, we use pap smears in this country to detect precancer of the cervix, long before cervical cancer ever develops.  Many women equate a gynecologic exam with a pap smear, which is just not always accurate.

Most cervical cancers are caused by the HPV virus.  That is correct; a virus CAN cause cancer.  In fact, viruses can cause many cancers, including penile, laryngeal (throat), oral (tongue and tonsillar, for example), anal, vulvar, and vaginal cancer.

HPV is thought to be transmitted sexually, although there have been reports of lower genital tract HPV in women who have never been sexually active.  HPV is common.  In fact, approximately 80% of women will be HPV-positive at some point in their lives.  And usually (thank goodness), HPV is transient.  That means that although many women may have HPV at some point, most will “clear it” or it will become undetectable to the technology we have today.

There are many subtypes of the HPV virus.  The two most dangerous (the ones that are most likely to cause cervical cancer) are types 16 and 18.  We now have the technology to test for these specific subtypes of HPV.

Pap smears are categorized to let the gynecologist know if further testing needs to be performed.  Remember, a pap smear is a screen.  It is NOT a diagnostic test.  We can tell by the result if we need to perform a more accurate test, like HPV testing or colposcopy.

In my next blog, I’ll explain colposcopy and discuss the actual guidelines.