Not Your Grandmother’s Pap

Gena Anderson

I know, I know, it’s the thing we all dread and don’t like to talk about. We drag ourselves to the doctor, 6 months overdue, after that reminder card resurfaces from the bottom of the junk mail pile. Maybe you’re more modern and received a patient portal reminder. However we wind up in those stirrups, I want us all to know just exactly what we’ve gotten ourselves into. I know for years I went through this experience blindly and assuming things that weren’t true. So, take a minute to read about the realities of the modern pap smear, what it is and what it’s not. 

The truth, the whole truth, and nothing but the truth about cervical cancer screening.

A pap smear is a screening test for cervical cancer, in the same way a mammogram screens for breast cancer. Your health care provider attempts to get an adequate sample of cells from the entire surface of your cervix (which is the lower part of the uterus), as well as from the tissue just inside the opening of the cervix. The cells will then be examined by a pathologist and determined to be normal or abnormal. If abnormal cells are identified, it will be graded and this grading of abnormality guides your provider on further testing and frequency of monitoring. The whole point is to detect cervical cancer early, or before it ever develops. Guidelines recommend pap smears for women age 21-65, and those 30 and older will also be concurrently tested for Human Papilloma Virus (HPV), the virus associated with cervical cancer. HPV results also factor into the follow up decisions. The good news is that most women don’t have to do this near as often as we used to. The recommended interval for testing is every three years for negative pap smears, and every five years if there was also HPV testing that was negative. I don’t know about you, but I really like that part!

Now that we’ve covered the basics, let’s uncover some myths that women often believe about the dreaded pap smear. These are all things I’ve heard my patients say, and I think it’s helpful to clear the air, and see the beast for what it is, and what it’s not. Here are the pap smear myths, in no particular order.

Myth: I need a pap smear to check for sexually transmitted infections.

While HPV is a sexually transmitted infection that can be detected with a pap smear, it’s unlikely that other infections will be detected without specific testing. If you are concerned you may have a sexually transmitted infection you should tell your provider so they can test appropriately. Most health care providers will offer this type of testing at an annual visit, but don’t assume you are being screened for sexually transmitted infections if it hasn’t been discussed. 

Myth: A pap smear checks for uterine or ovarian cancer.

While a pap smear is done during a pelvic exam, which includes an external exam of the uterus and ovaries, there is no specific test to screen for uterine or ovarian cancer. Your provider may find an enlarged or otherwise abnormal-feeling uterus or ovary, which is why we perform the full pelvic exam, but they can’t usually see if you are developing cancer. It’s important for every woman to know their family history, if possible, and pay attention to things like your menstrual cycle, bleeding outside of your menstrual period, pelvic pain, or other unusual changes with your body. Talk to your provider about these things so that proper evaluation can be determined.

Myth: Every five years is too long to wait between pap smears.

It’s understandable why women would be concerned about this one. For so many years we had to do this annually, and now we don’t. Some are thrilled, and others are uneasy. The reasoning behind the change is that science tells us it takes at least ten years for HPV to cause cancerous cells to develop. A woman who has a negative pap smear, and a negative HPV screen has very little chance of developing abnormal cells in the next five years, much less cancer. 

Myth: I’ve been married for a long time so I don’t really need to keep doing pap smears.

This one is dangerous, and has led to many women being diagnosed with cervical cancer rather than simply abnormal cells. Get your screenings at the recommended interval, so than any abnormality can be detected early, and cancer can be prevented.

Myth: I don’t need a pap smear because I feel fine.

Cervical cancer does not always show signs, and abnormal cells that have not yet developed into cancer usually are completely without symptoms. 

Myth: Cervical cancer doesn’t run in my family, so it’s not important to have a pap smear.

Though genetics likely plays a role in most cancers, cervical cancer is most strongly associated with exposure to HPV, and screening recommendations are not based on family history.

Not all cancers are easily detected early and prevented from advancing. Cervical cancer has been well-studied and we have excellent guidelines to screen for and prevent it. Share this information with the women in your life, and encourage each other to be and stay well.

This is not intended as medical advice and should not replace that of your own personal healthcare professional.

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