Medically Reviewed by Joycelyn C. Schindler, MD
Speaking to a group of women at McLeod Seacoast, McLeod OB/GYN Joycelyn Schindler, M.D., helped clarify the question of when does a woman start, how often do you need and when do you stop having the Pap test for cervical cancer:
Here’s a summary of Dr. Schindler’s remarks
Some people are not sure how often they should come in, if they should come in at all or if they should continue having a Pap test until they die.
So when to start? I recommend when a woman is 21. Most people have heard three years after they have had intercourse or when a woman has any questions or concerns. But for me, it’s 21 because the incidence is very low. There are about 15,000 cases of cervical cancer per year, very low compared to other cancers.
When you’re younger, the immune system is effective in fighting off the virus. Some 80-85% percent of people who are sexually active are going to be exposed. It’s whether or not their immune system will fight off the virus that does not get incorporated into the cells in the cervix. Some 90-95% of people, who are exposed, fight it off. Those changes in the Pap smear will likely regress, and you don’t need any of those invasive biopsies or testing until 21.
How often to test? When you’re younger, age 20-29, every three years. You don’t need to test for the virus unless that Pap smear is abnormal. We call a reflex test. If it comes back atypical or shows any of the pre-cancer stages, we’ll test you to see if the virus is there and to determine whether you need biopsies. From age 30 to 65, it depends on your insurance company, but every three to five years.
I’m more in favor with HPV testing, which is to test for the virus, and to test every three years. That’s because the five-year studies have a few more outliers. So, I would say stick to every three years.
And when do you stop? I would say age 65, but there are caveats. If you have a hysterectomy before age 65 that was not related to any pre-cancerous lesions, you do not need any further Pap tests. If you’ve had HIV or any immune suppressive disorders, you would want to continue with Pap tests, because that virus can linger on.