Why Annual Pap Smears Are History – But Routine Ob-Gyn Visits Are Not

An ob-gyn explains current guidelines for cervical cancer screening and routine checkups. 

By Dr. David Mutch

In the recent past, women were advised to visit their ob-gyn every year for a Pap test, as well as a pelvic exam and breast exam. The Pap test, also called a Pap smear, is a screening test for cervical cancer.

Fast forward to today, and our advice has changed. Women should still visit their ob-gyn each year, and I’ll outline why that’s so important below. But we no longer advise women to have an annual Pap test. A big reason for the change: We now better understand the way cervical cancer develops over time—we know it takes many years to develop—so we’ve expanded the time between screenings.

We also now have two screening options to detect cervical cancer, the Pap test and the HPV test. (HPV stands for human papillomavirus—a virus that can cause cervical cancer.) With both tests, cells are taken from the cervix and tested. The Pap test looks for abnormal cells that may develop into cancerous cells over time. The HPV test looks for the strains of HPV that are most likely to cause cancer.

Here’s a quick summary of ACOG guidelines for cervical cancer screening (read this FAQ for the full details):

  • Women age 21 to 29 should have a Pap test alone every 3 years. HPV testing alone can be considered for women who are 25 to 29, but Pap tests are preferred.
  • Women age 30 to 65 have three options for testing. They can have both a Pap test and an HPV test every 5 years. They can have a Pap test alone every 3 years. Or they can have HPV testing alone every 5 years.
  • After age 65, you can stop having cervical cancer screenings if you have never had abnormal cervical cells or cervical cancer, and you’ve had two or three negative screening tests in a row, depending on the type of test.

Exceptions to the guidelines

You may need more frequent screenings if you

  • have a history of cervical cancer
  • are HIV positive
  • have a weakened immune system
  • were exposed before birth to diethylstilbestrol (DES, a hormone given to pregnant women between 1940 and 1971)

If you have had a hysterectomy, you still may need screening. And if you’ve had the HPV vaccine, you should still follow the guidelines. The vaccine doesn’t protect you against every type of HPV.

Doctor’s notes

Most women are exposed to HPV in the course of normal sexual activity if they’ve had more than one sexual partner. The reason we don’t do Pap tests before age 21 is because the likelihood of someone that young getting cervical cancer is very low. After age 65, the likelihood of having an abnormal Pap test also is low.

Why you should have a routine ob-gyn visit every year

Whether or not you are due for cervical cancer screening, you should still see your ob-gyn at least once a year. Your routine visit is a good time for you and your ob-gyn to share information and talk about your wishes for your health care.

During your visit, you and your ob-gyn can talk about any number of common concerns, such as problems with sex or birth control, pelvic pain, or abnormal bleeding.

You also can talk together about whether you need a breast exam or pelvic exam. Plus, you can discuss testing for STIs (sexually transmitted infections), getting the vaccines you need, having your blood pressure checked, and other general medical issues.

The routine visit to your ob-gyn is crucial for your overall health, and cervical cancer screening is just one small—but important—part of that.

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