The Pap smear is a dreaded appointment for many but, thanks to this handy screening tool, cervical cancer rates and complications from HPV have seen a decline.
Increased screening has led to earlier detection of cervical cell changes and with it, led to earlier treatment. Today, Pap smears are incorporated into regular screening for individuals with a cervix. However, when and how often you get tested can differ depending on your country, age, and past HPV status. Read on to learn more about screening in your location.
First, what is a Pap smear?
The Papanicolaou-stained (Pap) smear was introduced in 1949 by a pathologist named George Papanicolaou. The Pap smear is now the primary screening tool used to assess abnormal cervical changes and screen for the risk of cervical cancers.
The Pap smear involves taking a cell sample of the cervix and assessing for any abnormalities. By monitoring cell changes, earlier treatment and interventions can be implemented which can prevent more severe disease.
While Pap testing and increased screening have resulted in a decline in cervical complications, there remains some debate over how often early screening should take place. Considering 90 percent of HPV infections will regress over time, screening can also lead to harm such as unnecessary stress on the individual, additional follow-up testing and biopsy, and the potential of unnecessary treatment.
The chances of having an abnormal Pap smear are higher in young individuals and decrease with age. Around 10% of individuals with a cervix aged 20-29 years will have an abnormal test result while only 1.6% of those aged 60-69. Of these abnormal results, 1.5% of 20–29-year-olds will have high-grade lesions that lead to further testing and biopsy. However, more than 50% of these will undergo treatment. Many of these infections would clear on their own and lead to no complication of cervical cancer.
For this reason, many countries recommend screening at a later age. Here is what is recommended in Canada, the UK, and the US.
Screening Guidelines Differ Depending on Country
The Canadian Task Force on Preventive Health Care recommends the following screening for asymptomatic individuals with a cervix without a previously abnormal test and who are sexually active.
- Screening is not recommended for individuals under 24. The potential harms in this group out weight the benefit of early screening.
- For individuals with a cervix aged 25-29 screening is weakly recommended every 3 years. The concern for cervical cancer increases in this age group, therefore there are benefits to screening.
- For those aged 30-69 routine screening every 3 years is strongly recommended. In this age group, the risk of cervical cancer is greater, and screening offers preventative benefits.
- At the age of 70 regular screening may be ceased.
In Canada, the recommendations are used as guidance to be used in discussions with patients. Some women may place a higher value on avoiding cervical cancer and would want to undergo more frequent or earlier screening. While others may prefer to follow the screening guidance.
The US Preventive Services Task Force sets the screening guidelines in the United States. The US recommendation incorporates high-risk HPV testing, which can help detect high-grade cervical lesions by identifying strains more likely to cause cervical cancers. They recommend the following:
- Screening begins at age 21-29 and should be followed up every 3 years with cervical cytology.
- In women aged 30-65, it is recommended to screen every 3 years with cervical cytology and every 5 years with high-risk human papillomavirus testing or every 5 years HPV testing in combination with cytology.
- The USPSTF recommends against screening in those under the age of 21 and over the age of 65 and those who have had a hysterectomy.
The UK has its own set of recommendations through the NHS Cervical Screening Programme. The NHS has also begun including HPV testing in its assessment. Cervical samples will be tested for high-risk Human Papillomavirus to help identify individuals more at risk for developing cervical cancer and implement treatment earlier. Their screening is recommended to begin at age 25 to 65.
- For those aged 25-49, screening is offered every three years.
- For those aged 50-64 years of age, it is recommended every five years.
What about for those who have had an abnormal Pap previously?
Screening guidelines differ if you have previously had an abnormal Pap and HPV has been detected.
If your Pap test was abnormal, you were likely referred to a gynecologist for a colposcopy. A colposcopy allows for a better view of the cervix and biopsy. Depending on your level of cell changes and health history, your doctor will recommend a treatment course of action or to watch and wait.
In those that have previously tested positive for HPV or had abnormal Paps that turned normal, your doctor will likely recommend follow-up testing a year after a normal result. HPV infections can recur, so it is important to stay on top of testing to see if cell changes recur over time.
Are you ready to respond to HPV?
The Benefit of Early Detection
Deciding when and how often to screen for cervical cancer and HPV, should be discussed with your medical doctor. Early detection has been beneficial in reducing our overall rates of cervical cancer. However, extra screening has also added anxiety and unnecessary procedures to those whose infections would have regressed within 12-36 months.
Moreover, detecting infection early also allows for earlier intervention with immune supports like Papillex and lifestyle changes like an anti-inflammatory diet, stress reduction, and exercise.