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
- 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