Celebrate! You Might Get A Respite from Yearly Paps

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It was that dreaded time of the year: Time for my annual exam with my gynecologist. No woman ever enjoys this day. But we do it. Like good soldiers, we march down to that office and do our preventive health care duty.

So, imagine my surprise when, at the end of this year’s visit, my doctor suggested that I start doing my Pap test every three years. Was I overjoyed? Did I do a little dance in the stirrups? Was I relieved? No, no, and absolutely not. In fact, before I even had my wits about me, I found myself protesting. I outright demanded that I keep getting that yearly Pap that I’d been enduring for nearly 20 years! And so, just as quickly as she had offered me the reprieve, she told me that I could continue to come in yearly for my Pap tests.

Looking back, I can see why I reacted the way I did. I’d assumed that the new guidelines were some sort of mandate handed down by insurance companies. I thought they were cutting costs on yearly testing – potentially at the expense of my health. As it turns out, I was wrong. It took a discussion with One Medical’s San Francisco doctor, Alicea Wu, to truly understand the ins and outs of the new Pap guidelines. Here’s the information you need to know:

Q: Let’s start at the beginning. What is a Pap test and what does it test for?
A: When you get a Pap, your health provider will collect cells from your cervix (the opening of your uterus) and send them to a lab to be analyzed. The pathologist at the lab will examine the cells for microscopic changes that indicate cervical dysplasia, which is a precursor to cervical cancer. Sometimes they will also look for the presence of Human Papillomavirus (HPV), which is the virus that causes cervical dysplasia and cervical cancer. (To learn more about HPV, click here.)

Q: What does it mean if my Pap comes back “abnormal?”
A: There are many different types of abnormalities that can come back on a Pap test, ranging from not-so-serious to very serious. The more unusual (or “atypical”) the cells, the closer they are to becoming cancerous. The pathologist will grade the abnormality, which will allow your doctor to decide what sort of follow up–if any–is necessary.

Q: For years, we’ve been trained to think that we need to get Pap every year. When and why has that changed?
A: In November 2009, the American College of Obstetrics and Gynecology issued new guidelines recommending that women get cervical cancer screenings less frequently than was previously the norm. Research has shown that screening less frequently is equally effective in preventing cervical cancer. Cervical cancer is a slow-growing cancer, so screening every two or three years is acceptable in certain low-risk women.

Women with normal Pap tests in the preceding few years are considered low-risk for developing cervical cancer and can follow these general guidelines:

  • First Pap test at 21 years old
  • 21-30 years old: Pap test every two years
  • 31-64 years old: Pap test every three years
  • 65 years or older: No more Pap tests necessary
  • Women who have had hysterectomies for non-cancerous reasons: No more Pap tests necessary

Q: If I want to keep getting my Pap every year, can I do that?
A: If you’re concerned about the new guidelines, talk to your One Medical provider about the frequency of Paps that works best for you. We will perform them annually for patients who prefer it, but most patients are comfortable waiting out the new intervals once they understand the guidelines.

Q: Is there a downside to being tested more frequently or earlier than scheduled?

A: Yes. Excessive screening may lead to unnecessary procedures that could cause harm down the road. For example, when certain follow-up procedures are performed, they have the potential to alter the cervical anatomy, which could lead to premature birth in a future pregnancy. Plus, some Pap abnormalities resolve on their own, without any intervention, and getting tested earlier may not give your immune system enough time to clear the abnormal cells.

The new guidelines may take some getting used to, but the idea behind them is to make your life easier while still allowing adequate time to detect potential problems. For most of us, fewer medical tests mean less stress and anxiety!

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The One Medical blog is published by One Medical, an innovative primary care practice with offices in Boston, Chicago, Los Angeles, New York, Phoenix, the San Francisco Bay Area, Seattle, and Washington, DC.