Friday, 27 September 2013

Screening: The New Pap Test Guidelines & You

Last year Cancer Care Ontario (CCO) changed the guidelines for cervical pap tests and some people are still confused or a bit nervous about the new recommendations. 
For many years we have asked women to come for pap tests starting as early as their teens and returning as frequently as once a year. After extensive research CCO now recommends starting pap tests later and only doing them once every 3 years for most women.  

For those of us that grew up in the "never never never ever ever ever ever miss your annual pap test" years this can be a bit disconcerting. So let's do a quick Q&A on cervical Pap tests.

What does a Pap test screen for?
  • Cervical cancer & cervical cell changes that occur before cervical cancer.
  • In Ontario 550 women/yr are diagnosed with cervical cancer. 160 die from it.
  • Cervical cancer is caused by human papillomavirus (HPV).
  • Intimate contact spreads HPV so most people are exposed at some time.
  • In the vast majority of people HPV disappears within 2 years on it's own & there is no disease However, in some women HPV stays for longer and causes abnormalities in cervical cells that lead to cancer. 

What does a Pap test not screen for?
  • Ovarian cancer: no screening test. ask your provider if you have concerns.
  • HIV: there is a blood test that you can request from your provider.  
  • Chlamydia: there is a urine test or cervical/urethral swab. ask your provider.
  • Gonorrhoea: as above.
  • Other sexually transmitted infections: ask your provider. 
  • Pregnancy: there is a urine test and a blood test. ask your provider. 

Why did the rules or guidelines for Pap tests change?
  • after extensive research of large female populations studies were not able to prove that there was any benefit to annual pap tests or early pap tests
  • cervical cancer in women under age 21 years: 
    • incredibly rare rate:  0.34 per 100,000 in a 5 year period
    • no cervical cancer deaths in women in this age group
    • above cases would not likely have been detected by Pap tests
    • harm of performing paps significantly outweighs the benefits 
    • treating cell abnormalities in young women may lead to problems in later pregnancies including preterm delivery & low birth weight
  • cervical cells change slowly & can be detected by a pap test long before cancer develops

Who should have a Pap test?
  • any woman over the age of 21 years who has ever been sexually active
  • "Sexually active" includes intercourse, oral sex, and digital contact
  • women who have had a sub-total hysterectomy (still have a cervix)
  • pregnant women but only if due for a pap test (not more frequent)
  • women who have sex with women
  • women who have received the HPV vaccine

When should Pap tests start?
  • starts at 21 years of age for women who have ever been sexually active
  • Women who have never been sexually active do not need a pap test

How often are Pap tests needed?
  • Never had abnormal pap result: every 3 years
  • Previous abnormal pap result: require more frequent pap 
  • Previous treatment of abn cells: require more frequent pap, likely annual
  • Immunocompromised women (e.g. immunosuppressant drugs): require annual pap 

When should Pap tests be stopped?
  • age 70 years provided you have had 3 normal pap tests in the past 10 years
  • after total hysterectomy if there is no history of cervical cancer or dysplasia or HPV

If I have never had a Pap test before and I am nervous what can I do?
  • It's very normal to be nervous whether it is your first pap test or your 30th. Talk to your provider. Most RNs, NPs & MDs are happy to give you information and answer questions. 
  • You can also look at on-line information like the websites listed below.

If I had the HPV vaccine do I still have to get a Pap test?
  • Yes. The vaccine does not prevent all HPV strains that can cause cancer.
  • The HPV vaccine does prevent 70% of the strains that can cause cancer. 

Who can perform a Pap test and how do I book that? 
  • RNs, Nurse Practitioners & Doctor's can all perform pap tests
  • Book an appointment at your clinic
  • If you don't have an NP or MD call Health Care Connect 1-800-445-1822
  • some Public Health Unit & Community Health Centres also perform pap tests

How do I prepare for a Pap test?
  • the week after your period is the best time for a pap test (but not required)
  • try to have your pap test when you do not have your period
  • avoid using tampons, vaginal creams/lubricants/medications, or having intercourse 48 hour prior to your pap test

Thanks for reading Getting Healthy with NP Sam. Comments are welcome. Please click the pencil icon below. 

References & Links for more information:

Society of Obstetricians & Gynaecologists of Canada - My First Pap Test & Pelvic exam
Cancer Care Ontario - Cervical Screening
Cancer Care Ontario - Cervical Cancer
Cancer Care Ontario - Human Papilloma Virus Vaccine
Society of Obstetricians & Gynaecologists of Canada - HPV Info
Sexuality and U (SOGC)
Menopause and U (SOGC)
CCO Evidence & References for Research supporting new Guidelines
Info for Healthcare Providers on Cervical Screening


Anonymous said...

What are the strains of HPV that can lead to cancer? How often should you test for HPV? And if tested positive, how soon after should you test to see if your body has cleared it up...or not?

Thank you in advance...great info!

Samantha Dalby said...

Thanks for your questions. There are more than a hundred strains of HPV. 99% of cervical cancers are caused by high risk strains the most common of which (70%) are strains 16 and 18. HPV testing is not routinely performed. HPV is so common that we believe all people have it at one time or another. Their bodies clear HPV without treatment usually in 6 months to a year. Therefore we only consider HPV testing if the cervical Pap test shows abnormal cells and we want to see if it is a high risk strain of HPV. However, in some provinces this test is not covered by OHIP although extended health plans will sometimes cover the expense. If you had an abnormal pap result then your Pap test IS repeated. Depending on the initial result the repeat is usually in 6 months.