Apparently You Don’t Need an Annual Pap Smear Anymore

This article was originally published at Zelda Lily

I hate Pap smears. Absolutely hate
them. Not just because of their invasive nature, but because I have
what doctors like to call a "sensitive cervix." While most people just
feel some pressure when that awful metal contraption clamps down on
them, I feel pain. Intense pain. And I feel even more pain when they go
in there with that stupid broom thing. The doctors and nurses all
assure me that there is nothing wrong with me; I’m just one of those
rare souls who’s especially sensitive cervically. I had my annual Pap
smear nearly 12 hours ago. I’m still a little sore.

My appointment was with a brand new doctor, since I just moved here
to Seattle a year ago. As I sat whimpering in her office and warning
her to be gentle and quick, she said, "Well, dear, after this one,
you’ve graduated to the next level of Pap smear. You only need it every
two years now." I asked her to repeat that. She explained that they
know a lot more about cervical cancer these days, and that it’s caused
almost exclusively by the HPV virus (typically transmitted sexually),
and apparently once you’re over the age of 26, you’re good to go with
screenings further between. Her explanation for this was that your risk
of HPV increases with the number of sexual partners you have. As women
get older, she said, they have fewer sexual partners, so their risk of
infection is lesser. "If you only have sex with one guy every one or
two years, you’re fine just getting tested every couple of years."

I was a little offended by this. Like, I’d already told her I didn’t have a boyfriend, but do I look
like someone who only gets laid once every two years? (No.) I mean, I’m
delighted at the prospect of not going in for this shit every year,
but, especially after British reality star Jade Goody died of cervical
cancer last month, I’m hyper-aware of it and I want to make sure I’m
protecting my health — even if it involves some extreme discomfort. So
I did a little research of my own when I got home.

I found a fascinating article published by the New York Times
earlier this month. It discusses a new DNA test that does a better —
and earlier — job of detecting HPV, and it will likely replace the Pap
smear. Not just that, but it could likely mean you only have to get
your cervix swabbed once every 3, 5 or even 10 years, depending on
which expert is asked. GOOD NEWS FOR ME!

Their optimism is based on an eight-year study of
130,000 women in India financed by the Bill and Melinda Gates
Foundation and published last week in The New England Journal of
Medicine. It is the first to show that a single screening with the DNA
test beats all other methods at preventing advanced cancer and death.

The Indian study, begun in 1999, divided 131,746 healthy women ages
30 to 59 from 497 villages into four groups. One group, the control,
got typical rural clinic care: advice to go to a hospital if they
wanted screening. The second got Pap smears, the third got
flashlight-vinegar visualization, and the fourth got a DNA test, then
made by Digene, which is now owned by Qiagen. The company did not pay
for or donate to the study, its authors said.

After eight years, the visualization group had about the same rates
of advanced cancer and death as the control group. The Pap-smear group
had about three-fourths the rates, and the DNA test had about half.

Significantly, none of the women who were negative on their DNA test
died of cervical cancer. “So if you have a negative test, you’re good
to go for several years,” Dr. Blumenthal said.

The study’s chief author, Dr. Rengaswamy Sankaranarayanan of the
International Agency for Research on Cancer in Lyon, France, said,
“With this test, you could start screening women at 30 and do it once
every 10 years.”

There’s some hesitancy to adopt less frequent screening in the U.S.,
because doctors use the annual Pap smears as a way to get women into
their office to address a wide range of health issues. But get this: Since
1987, the cancer society and the American College of Obstetricians and
Gynecologists have recommended Pap smears only every three years after
initial negative ones.
That’s right! They’ve been saying for over
TWENTY YEARS that we could come in less frequently for that horrid
procedure. But they don’t want us to know that, because they want our
butts in their office every year to get our tits checked and our uterus
pushed around.

Says Debbie Saslow, director of gynecologic cancer for the American
Cancer Society, “The average gynecologist, especially the older ones,
says, ‘Women come in for their Pap smear, and that’s how we get them in
here to get other care.’ We’re totally overscreening, but when you’ve
been telling everyone for 40 years to get an annual Pap smear, it’s
hard to change.”

Obviously, you should get your butt (and cervix!) to a gynecologist any time you
have concerns about your body, but this news absolutely delights me,
and I’m annoyed that I wasn’t told about it earlier, especially since
my past doctors knew how much the procedure traumatized me. But I
always felt that if I didn’t get my annual Pap, I was putting my health
at risk. So not only does this take a huge annual burden off my
shoulders, but the new DNA testing offers a lot of hope to women in
third-world countries, where cervical cancer kills more than 250,000
women a year — that number is just 4000 in the U.S.

Medical science, my cervix salutes you. Now back off.

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  • invalid-0

    Does this hold true for two virgins who married and have been monogamous?

    • invalid-0

      You don’t need smears at all – if you were both virgins and are in a mutually exclusive relationship…smears are not going to benefit you BUT are very likely to harm you.
      Virgins – DON’T even think about it!
      The smear is very unreliable and produces lots of false positives (and false negatives)
      Cervical biopsies are unpleasant, embarrassing and distressing and can leave you with damage causing problems with fertility, during pregnancy and psychological issues.
      Don’t let any doctor push you into smears – YOUR informed consent is required….make sure that requirement is respected by your Dr or find another one! (or report him/her)
      Low risk women also may prefer to skip smears or start them later or have them less frequently…
      It’s very risky to have smears before you’re 30 as the cervix changes over these years and you may have treatment for something that does not require medical intervention. (leaving you with long term problems)
      Testing too frequently carries risks – annual and two yearly means 95% and almost 78% of women respectively will face biopsies in her lifetime.
      The “best” (although I still think it has an unacceptably high number of false positives and biopsies (at 55%)) program is based in Finland – starting at age 30 and then 5 yearly until 50, 55 or 60 (depending on risk profile and past results)
      As a low risk woman, I have declined smears.
      Dr Angela Raffles (UK cancer screening expert) put the risk of this cancer in persepctive – after all the medical scare campaigns – 1000 women need regular testing for 35 years to save ONE woman from cervical cancer! How many women are harmed in that time by this unreliable test?
      Also, note that doctors in the UK and Australia are paid to reach high screening targets that has led to highly unethical behaviour.
      Sadly, women need to protect themselves from the medical profession – there are lots of vested interests ready to take chances with your health!

  • invalid-0

    They also like to hold women hostage to these horrid procedures to get their BC pills. Even though the tests are totally unrelated to the pill. Contraindications for use include high blood pressure, smoking, migraine, etc and other vascular problems. Who is going to do something about that?? In London, there are pilot programs to make the pill available OTC.

  • invalid-0

    Do NOT go more than one year without your HPV DNA test!!! My last pap was in NOV 2007 and everything was normal (however no HPV DNA test was run). My most recent pap was in 2009. Thankfully it turned up abnormal, because my nurse practitioner did NOT run the HPV test along with it. (Um, yes, you can have a normal pap and still test positive for HPV.) My abnormal pap report got me referred to a gyno…her first questions was, “Hmm, I wonder why she (my nurse practitioner) didn’t run an HPV test?” ((Because I am a 30 year old who has been sexually active in the past year)) Anyway, I tested positive for HIGH RISK HPV DNA…meaning, I contracted strain(s) of the high risk HPV virus that doesn’t cause warts like the low strains, mine can eventually lead to cervical cancer!

    So, what if I tested negative for HPV in 2007 and took the advice of what I think is being misinterpretted from this Indian study and didn’t see my GYN this past January???? I would have continued my lifestyle and relationship as usual, exposing myself to viral loads of HPV DNA! I wouldn’t have found out I had HPV until probably I started to have active symptoms (which means the SOB had become more invasive in my cells, probably an early stage or latter form of cervical cancer…because “just” an HPV infection does not have any signs or symptoms)

    I have met three other gals in the last two weeks in my same situation—they however are in their early 20s. They went from normal pap to HPV positive with some form of cervical dysplasia by the time they had their next pap the following year.

    Oh my God! PLEASE stay pro-active in your health! If you are sexually active, definitely follow up with your gyno on a regular basis!!! Especially now, since it is rare to encounter any relationship that has only ever involved just two “monogomous” people. When you sleep with someone, you are sleeping with whomever else they have slept with in the past…their former ex-wife/husband/boyfriend/girlfriend, their highschool sweetheart, their one-night stand, etc.

    Save the Vajayjay’s!!!

  • invalid-0

    You are misunderstanding how cervical cancer develops. Firstly, the vast, vast majority of people who are exposed to the cancer-related strains of HPV will never develop any cervical changes, let alone cervical cancer. More than 80% of people are exposed to HPV, and most of them will clear the virus (as in, it’s completely gone and they would no longer test positive) within two years. I’m not sure what you mean by “viral loads of HPV DNA,” but the fact is that HPV does not “multiply” the longer you have it in your body: it’s more likely that the opposite would happen and your body would eliminate the HPV.

    If I’m reading your comment correctly, you had a normal pap test in 2007 with no HPV test. Then you had an abnormal pap test in 2009, after which an HPV test was run and it was positive. First off, there is no way to know (since a test was not run at that time) that you were not positive for HPV in 2007 and it had not caused any cervical changes yet. In fact, you could have contracted HPV years before that and it did not cause an abnormal pap test until 2009.

    Finally, let’s say you follow the American Cancer Society’s advice and get pap tests every two or three years, so you have a negative test in 2007 and wait until 2010 to get retested. You seem to be thinking you would have invasive cancer if you followed this plan. That is highly, highly unlikely. What is more likely is that you would have either cleared the HPV by 2010 (meaning you would never have had an abnormal pap) or you would have an abnormal pap test in 2010, but the degree of cervical changes would not be any different (that is, worse) that the abnormal pap test you got in 2009. It is extremely rare fpr cervical dysplasia to progress that quickly unless you are immunosuppressed. Getting pap tests annually does not prevent any more cases of cancer than getting them every three years.

    I highly, highly recommend that everyone read the full guidelines for cervical cancer screening by the American Cancer Society:

    There’s also this really good New York Times article, although it is a bit out of date now:

  • invalid-0

    I’ve never had a pap smear…
    I was lucky, very lucky…as a young laywer I was asked to research the value of cervical screening. I was shocked at the information that is deliberately withheld from women.
    Our healthy young client had been left with an incompetent cervix after a false positive – women under 30 and women tested annually and biannually have a HIGH chance of a false positive. Annual screening means 95% face the trauma and discomfort of a false positive, 3 yearly – 65% anf five yearly – 55%….
    This test is MUCH nore likely to harm you, than help you…
    A high risk woman has a very small chance of benefiting…a low risk women a VERY HIGH chance of harm.
    I rejected screening – the scare campaigns don’t work when you have the fatcs. My risk profile made clear this screening was more likely to harm me, than help me….the risks exceeded the benefits.
    Every women should have the opportunity to make that assessment for herself – but that doesn’t happen, women are deceived – the risk of the cancer is exaggerated, the benefits of the test overstated and the significant risks are not mentioned….
    Annual screening is a BAD practice – it means most women will have a colposcopy and biopsies with only a very small number having any sign of malignancy.
    Dr Angela Raffles (UK cancer screening expert) released some mind blowing statistics…1000 women need regular screening for 35 years to save ONE woman from cervical cancer. What? I thought it was an epidemic – another lie, it’s an uncommon cancer, always was…
    The medical profession has lied and deceived women and adopted unethical practices to “recruit” women and force compliance – this is an uncommon cancer and an unrelaible test…much more likley to harm you.
    Smoking is a FAR, FAR greater risk to your health.
    This is about controlling women and making a fortune…every year thousands of healthy women become unhealthy women thanks to this screening….damage to the cervix from false positives and unnecessary biopsies which cause emotional problems, infertility and problems during pregnancy.
    Women need to do their READING and become informed…your Dr has a conflict of interest….informed consent has been ignored in favour of population coverage and making money.
    Refuse this screening if you’re not satisfied with the test…and report any Dr trying to force you into screening.
    Any Dr who requires screening before giving you the Pill is ignoring the need to obtain your informed consent and should be reported….
    Look at other countries – we don’t have routine pelvic exams – totally unnecssary in asymptomatic women and cancer screening is optional…breast exams are NOT recommended for women under 40….women are being used as money making objects and are being harmed in the process.
    I’m so grateful I was obliged to research this subject 30 years ago – I was able to refute all my Doctor’s arguments – she simply marked my file “informed patient” and left it at that…it disgusts me how women are treated by the medical profession.
    This testing does not make sense – neither does breast cancer screening – do your reading and make your OWN decision whether to particpate or not…..

  • invalid-0

    I feel that paps are not that dangerous as doctors pretend them to be!

  • invalid-0

    Earlier was, that in development of cancer cages the leading role is played by fiber Ras, and is more true, a quantity of biochemical reactions which the given fiber enters, – so the called Ras-cascade. Researchers thought, that they as a result and characterise both regeneration of cages in malignant, and their further division.

    However the Austrian science officers, studying fiber Raf-1, have checked up, that directly it is responsible development of the cancer have swelled up. Mice which methods of gene engineering have deprived of power to synthesise Raf-1, have appeared are not subject to a skin cancer. Including so far as at them in an organism it was synthesised Ras which was guilty of formation of tumours earlier, mice all precisely also remained healthy.

  • domagoj

    I am a 44 year old wife and mom of three
    boys and at two different times in my
    life, I have had pap smears come back abnormal. Once when I was 21, and again when I was 42. Back in the early 1980’s, when my pap came back abnormal, I had to have a biopsy and I was dx’d with “Dysplasia.” (sp?). Back in those
    days, the remedy was to have “Crio-Surgery (sp?) where the doctor would freeze the abnormal cells in the cervix. Doctors do not believe in this form of surgery anymore, as I was told by my present ob/gyn. My 2nd pap smear at age 42, came back abnormal b/c my cervix had moderate inflammation. My Dr told me that my cervix was twisted, red and just a mess. The reason? The surgery I had to fix my first abnormal pap smear! It’s unfortunate that I had to undergo the surgery in my past that made my cervix today so twisted. My doctor said it would probably be next to impossible to ever get pregnant again but that’s good, b/c we don’t want anymore children, but what’s going on in my cervix is not a good thing. I cannot emphasize how important it is for women of all ages to get their annual pap smears. BTW, my most recent pap came back normal, finally!