Paps & Cervical Cancer
The Papanicolaou test (Pap smear or Pap Test) is used to test of a sample of cells taken from a woman's cervix. The test is used to detect premalignant and malignant (cancerous) processes that may develop into or indicate cerivcal cancer. Below are the current Pap Tests recommendations for women.
Cervical Cytologic Screening Guidelines
America College of Obstetricians and Gynecologists, 2009
| AGE | RECOMMENDATION |
| Under 21 yr | Avoid screeing |
| 21 to 29 yr | Screen every 2 yr |
| 30 to 65 or 70 yr | May screen every 3 yr* |
| Between 65 and 70 yr | May discontinue screening** |
**This recommendation applies only to women with three or more consecutive negative cytologic tests and no abnormal tests in the preceding 10 years; exceptions include women with multiple sexual partners.
Facts about Pap Smears, HPV and Cervical Cancer
1. The incidence of cervical cancer in a women under 30 is less than 1%.
2. Cervical cytology or pap smears has reduced the incidence of cervical cancer by 70%. However, it remains a leading cause of death in developing countries without screening programs.
3. Cervical cancer has a long preinvasive state, often 10 years or more.
4. Cervical cytology screening (Paps, Thin Prep) can detect preinvasive and invasive cellular changes of the cervix.
5. Treatment of preinvasive disease if effective.
6. Most cases of invasive cervical cancer occur in women who have either never been screened or have either never been screened or have not been screened in the preceding 5 years.
7. Because of the high prevalence of HPV infection in women under the age of 30, there is no role for screening with HPV in this age group.
8. Human papillomaviruses are highly prevalent, tissue specific, DNA viruses that infect epithelial cells in humans.
9. Approximately 75-90% of HPV infection will clear within a year of infection by natural desquamation of the epithelial cells.
10. Persistent viral infection with oncogenic (cancer causing) type of HPV leads to cancer of the cervix, anus, vagina, vulva and penis.
11. Oncogenic HPV types include 16 (50% of CC), 18 (20%), 45 and 31 (5%. HPV 6 and 11 cause 80% of genital warts.
12. Cervical cancer is the 2nd most common cancer in women worldwide with a biomodel onset in the 3rd and 6th decade and is associated with persistent infection with high risk HPV (16 & 18).
13. The HPV vaccine, a quadrivalent HPV 6/11/18/19 vaccine (Gardisil) is now available. It is recommended for girls and women ages 9-26, is administered in 3 doses at 0, 2 and 6 months. Duration of immunity is unknown.
14. Routine HPV testing is not recommended prior to vaccination, but cervical cytology screening is recommended in sexually active women or women over the age of 21.
15. The safety profile for the HPV vaccine has been deemed excellent.
Links & Articles
Cervical-Cancer Screening - New Guidelines and the Balance between Benefits and Harms
The New England Journal of Medicine
Screenings for Cervical Cancer - Recommendations and Rationale
U.S. Preventive Services Task Force
