A pap smear is a test performed to check for cervical cancer. This is considered routine, yet life-saving care for patients with a cervix.
A speculum exam is used to see the cervix and a brush is used to collect a sample of the cervical cells for testing. This sample is collected from right at the entrance of the cervix. The brush does not go into the uterus and nothing is cut or removed to get the sample.
For most people, the actual pap smear itself causes slight cramping when the cervix is touched, but it should not cause severe pain. The speculum exam is usually the most uncomfortable part of a pap smear.
What Does a Pap Smear Look For?
A pap smear looks at two separate changes in the cervix to determine your risk of cancer and the next steps in management.
Cervical Cell Changes
First, the pap looks for changes in the cells of the cervix. A normal pap will tell you that there are no changes to the cells of the cervix.
There is much variation in what is considered abnormal with cervical cells on a pap. Some changes are low risk, some are high risk, and some are unknown.
If the changes in cervical cells come back abnormal, it does not immediately mean you have cancer. It is important to review the results with your provider to determine the next steps in screening.
Some results mean your pap is repeated in a year while some results require immediate intervention.
HPV (Human Papilloma Virus)
The second piece of a pap smear looks for high-risk HPV (human papilloma virus) on the cervix.
HPV is the virus that puts you at risk for developing cervical cancer.
HPV typically has no symptoms, unless it is the strain that causes genital warts.
There are over 200 strains of HPV currently identified. When completing a pap smear, we are looking for the most high-risk strains that are most likely to cause cervical cancer.
If your pap smear comes back positive for HPV, it does not mean you have cervical cancer or a sexually transmitted disease.
HPV alone may be something that your body will get rid of on its own. Typically we repeat the pap in a year and it is gone.
If HPV is present with cervical cell changes, it may need further evaluation to ensure there is no sign of cervical cancer.
When Should You Get a Pap Smear?
Pap smear screening recommendations vary slightly between professional organizations.
All professional organizations agree that pap smears should not be performed on patients younger than 21.
This can be confusing for patients because in the past, we started pap smears at age 16 or as soon as a patient was having sex.
What we learned through research is that there are quite a bit of normal variations of change before age 21 that our bodies take care of on their own. The risk of developing cervical cancer before the age of 21 is less than 1%.
Healthcare providers were doing invasive procedures on young people’s cervices for changes that their bodies would manage without intervention. These procedures can have long-term consequences for patients. These reasons are why the recommendations changed to paps starting at age 21.
No More Annual Pap Smears
Another point all of the professional organizations agree on is that annual pap smears are no longer recommended or performed.
Annual pap smears are no longer evidence-based screening and do not bring beneficial information for cancer screening.
Many insurances are denying coverage for annual pap smears now because they are no longer considered evidence-based medicine.
Current Screening Guidelines
The American College of Gynecology and the United States Preventive Task Force recommend pap smear only every 3 years from age 21–29. At age 30–65, they recommend pap smears with high-risk HPV testing every 5 years.
The American Cancer Society recommends starting paps at age 25 with HPV co-testing every 5 years because the risk of cervical cancer before this age is low.
We also do not typically intervene with abnormal cell changes in ages 21–25 until we can test for HPV. For some people, early pap smears with no HPV testing can lead to repeat unnecessary pap smears until age 25 when HPV can be added.
It is important to find out what your provider recommends for pap testing and use shared decision making to decide which screening route is best for you.
Pap Smear and Cervical Cancer Screening in Greensboro and Across North Carolina
Haven Health provides routine pap smears and cervical cancer screening in Greensboro, North Carolina and by telehealth coordination across the state.
Patients from Greensboro, High Point, Jamestown, Oak Ridge, Summerfield, Kernersville, and surrounding Guilford County communities trust Haven Health for evidence-based, stigma-free reproductive healthcare.
If you live anywhere in Winston-Salem, Charlotte, Raleigh, Durham, Asheville, Wilmington, or anywhere in NC, Haven Health can coordinate your care and send orders for testing to be completed at a lab near you when needed.
Haven Health is committed to patient education, preventive care, and shared decision making for cervical cancer screening across North Carolina.