Doctor K: Pap test still needed, just not as often

DEAR DOCTOR K: I’m a woman in my 30s, and I’ve never had an abnormal Pap test. Do I still need one every year?

DEAR READER: The answer used to be yes. This helped ensure that you had regular Pap tests to screen for cervical cancer. But new guidelines recommend less frequent Pap tests for younger women, and no Pap tests for many older women.

The new guidelines, issued in 2012, revised the recommendations for cervical cancer screening. They suggest that women ages 21 to 65 have a Pap test every three years or, for women ages 30 to 65 who want to lengthen the screening interval, have a combination Pap test and human papillomavirus (HPV) test only once every five years. (Most cervical cancers are caused by specific types of HPV, a sexually transmitted virus.)

In addition, most women ages 65 and older and women who have had a hysterectomy (and no longer have a cervix) do not need to have Pap tests. The exceptions are women with a history of precancerous cells, cervical cancer or abnormal Pap/HPV tests.

The new recommendations stem from a better understanding of how cervical cancer develops. It doesn’t develop very rapidly. Rather, there are clear precancerous stages that take years to progress.

For cervical cancer and many other cancers, our screening tests are not perfect. With a perfect test, every time it came back abnormal there would really be a cancer – and that would justify additional invasive diagnostic tests. And with a perfect test, every time it came back normal you could know for sure that you were free of that cancer.

The bottom line: You still need the Pap (and the HPV) test, but not as often as you did in the past.

Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.

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