Doctor: Yearly pap smear frequently unnecessary
ERIE, Pa. – Dr. Carla Picardo wants to clear up the confusion about pap smears.
A pap smear is a routine procedure to test for cervical cancer in women. Cells are collected from a woman’s cervix – the lower, narrow end of the uterus – and checked for signs of cancer, infection or inflammation.
For years, a pap smear was part of a woman’s annual visit to her medical provider, usually an obstetrician-gynecologist. But the guidelines changed in 2012 and now, for most women, pap smears are recommended every five years.
But many women are still getting the procedure every year, said Picardo, an obstetrician-gynecologist with University of Pittsburgh Medical Center’s Magee-Womens Midlife Health Center in Erie.
“I see new patients who tell me they had still been getting pap smears every year,” said Picardo, who also is a member of the Erie County Board of Health. “I don’t know why there’s such a discrepancy in Erie. The guidelines are well established.”
The guidelines changed after it was discovered that nearly all cases of cervical cancer (99.7%) are caused by human papillomavirus infections. If a woman doesn’t have HPV, it is highly unlikely they later develop cervical cancer, Picardo said.
Here are the current guidelines for women with an average risk of cervical cancer, according to the U.S. Preventive Services Task Force:
Women ages 21-29: a pap smear every three years
Women ages 30-65: a pap smear and HPV test every five years, or just an HPV test every five years, or just a pap smear every three years
Women younger than 21 or older than 65: no screening needed
“There are women who still should get a pap smear every year,” Picardo said. “They include women with HIV
hhhand those who are immunocompromised, such as solid organ transplant recipients. Also, women whose mothers took (the hormonal drug) diethylstilbestrol when they were in utero.
“But this is a very small percentage of women.”
Picardo said that she was surprised that health insurers still reimburse providers for annual pap smears 12 years after the current guidelines were published.
“One thing that I can think of is that by the time the provider has explained why the patient doesn’t need one and why they wouldn’t be more at risk of cervical cancer, they could have done the pap smear,” Picardo said.
Despite that quickness and the routine nature of the procedure, Picardo said there are drawbacks to unnecessary frequency.
“Yes, it is a routine procedure, but it is still invasive,” Picardo said. “The more frequently you do a test, the more likely you may have a false positive result. If you do pap smear more regularly, there’s an increased chance you’ll find something that would resolve if it was just left alone to give a woman’s body time to clear it. If you screen too frequently, you’re more likely to intervene sooner than necessary, which leads to unnecessary procedures that may have more harm than benefit.”
The guidelines for mammograms aren’t as consistent as those for pap smears, Picardo said.
The U.S. Preventative Services Task Force recommends them every other year for women 50 to 74 years of age who are at average risk for breast cancer.
Meanwhile, the American Cancer Society recommends a mammogram every year from 45 to 55, then every other year for as long as they expect to live at least another 10 years.
Picardo recommended women talk with their provider if they have questions about any screenings.