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Pap Smears

Pap smears are a critical part of a woman’s hearth care and should be initiated at age 21. Cervical cancer incidence has decreased greater than 50% due to the

widespread use of pap smears. Furthermore, approximately half of all women

who are diagnosed with cervical cancer have never had a pap and an additional

100/0 of women with cervical cancer did not have a pap in the 5 years prior to

their diagnosis. This test is essentially a red flag raiser. An abdominal pap does

not tell us how extensive a cervical problem is. It does tell us that further testing

needs to be done to make certain cervical cancer or pre-cancer is not present


This next test is a colposcopy, which allows for better visualization of the cervix

and biopsy of abnormal areas. Cervical cancer and precancerous cells are

caused by a very common sexually transmitted virus Human Papilloma Virus

(HPV)- This virus has the potential to cause damage to cervical cells, yet if that

damage occurs it generally occurs relatively slowly starting with mild abnormality

that then worsens over time. The goal of a pap smear is to catch pre-cancer cells

so that they can be removed to prevent the development of cancer.


Having one pap smear is not enough for lifelong cancer surveillance. This is due

to the fact that a pap can be falsely normal. For this reason yearly pap smears

have traditionally been recommended. A series of normal paps statistically takes

away the risk of having a falsely normal pap. Recent research has changed this

yearly recommendation by the American College of Obstetricians and

Gynecologists. A lady who has always had normal paps, has the same sexual

partner, and has no chronic illnesses that affect the function of the immune

system can space her paps to every two years in her twenties and to every three

years in her thirties and beyond. It is important to note that these new

recommendations are for the pap test only. Every woman still needs to be seen

for a yearly gynecological exam to evaluate the breast1 uterus, ovaries, and her

overall health.


The annual gyn exam and pap smear does often lead to a great deal of anxiety

for women. I feel that it is important for women to know that they are not alone in

that common anxiety. It is our job as providers to make the experience of the

annual exam as free of stress as possible to enable our patients to effectively

utilize preventive measures such as the pap smear.