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The Rap on NOT Getting a Yearly Pap

Jan 27, 2016
By Kimberly Boyd
Hand holding pen circling the 10th on a calendar

“What do you mean I don’t need a Pap test this year?”  For many years, women have considered a yearly gynecologic exam and Pap test to be an essential — albeit unpleasant — aspect of staying healthy. That paradigm began to change in 2009 when the American College of Obstetricians and Gynecologists (ACOG) recommended that for women who have either never had an abnormal Pap test or for those who have had three normal tests in a row, the screening interval can be extended to every two to three years, depending on age.

But is this safe?

It’s not only safe to extend the time between Paps, it may also help protect you from unnecessary procedures. Here’s the background information: Pap tests detect early abnormalities in the cervix that are caused by certain strains of the human papillomavirus (HPV). If left untreated for several years (or perhaps decades), some of these abnormalities can eventually develop into cervical cancer. But most of the time, your immune system eliminates the HPV infection long before it causes cancer.

The problem is that if an abnormality is detected on a Pap test – even if it’s destined to go away on its own – your provider will be compelled to do further testing, such as a colposcopy and, in some cases, treat the abnormalities. This can cause significant harm (ranging from pain and anxiety to potentially compromised fertility) without producing any health benefits.

By spacing out Pap screenings in women who are at low risk for cancer, we can reduce the rate of over-diagnosis and unnecessary treatment. An extended interval between Paps gives the immune system more time to take care of HPV infections on its own. This strategy is safe because even if a cervical abnormality goes undetected for three years, it will still be easy to treat and will have been found in plenty of time.

Women who are at a higher risk of developing cervical cancer should continue to undergo annual screening. Talk to your health care provider if you think you are in this category. As a general rule it includes women with HIV or other immune system diseases, women who have been exposed to diethylstilbestrol (a synthetic estrogen banned in the 1970s), and women who have previously been treated for serious cervical problems.

How do I stay healthy?

  • Practice safe sex. Using condoms reduces the risk of getting new HPV infections; it also helps protect against other sexually transmitted infections.
  • Stop smoking: women who smoke while being infected with HPV have a higher risk of progression to cervical cancer. You’ll be doing your lungs and your cervix a favor by putting down the cigarettes. (Not to mention all the other organs negatively affected by smoking.)
  • Don’t put off your Pap indefinitely. They’re still key for preventing cervical cancer, which affects roughly 12,000 women in the U.S. annually. Be sure to stay on schedule for your Pap screening.
  • Remember that a visit to the doctor can involve much more than a gynecologic exam. For women who have chronic health conditions or are taking regular medications, a yearly physical exam is warranted even if a Pap test isn’t needed.
Kimberly Boyd

Kim takes a comprehensive, integrative approach to healthcare and values developing long-lasting partnerships with her patients. A compassionate listener and thorough physician, she enjoys helping patients alter their lifestyles for optimal health and wellness. As a former elite gymnast, Kim is also particularly interested in musculoskeletal conditions. She received a bachelor's degree in human biology from Stanford University and continued at Stanford for her MD. After doing her residency training in family medicine at Oregon Health & Science University, Kim completed a fellowship in integrative medicine in a joint program through Andrew Weil's Center for Integrative Medicine at the University of Arizona and Oregon Health & Science University. Kim is certified with the American Board of Family Medicine. Kim is a One Medical Group provider and sees patients in our Chicago offices.

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.

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