As a 30-something female, I've had many Paps. As a female doctor, I've performed many as well. My greatest concern, however, is the lack of information female patients are provided on the importance of cervical cancer screening, but also on the updated guidelines regarding the timeline for screening. For example, most women don't require a yearly Pap and women under 25 don't need them at all. When I tell patients this, they seemed surprised: "But my doctor says I need one every year" or "I was told I need one because I've become sexually active, even though I'm just 16." I thought I'd outline the guidelines for the general female patient here and hope they help alleviate some confusion.
When do I start cervical cancer screening?
The Canadian Task Force on Preventive Health Care recommends starting routine Pap tests at the age of 25. Routine Pap tests are NOT recommended for sexually active women under the age of 25. Routine Pap tests are also NOT recommended in women over the age of 25 who are not sexually active.
The Alberta TOP guidelines (Toward Optimized Practice) build on the Task Force suggestions, but highlight that for ages 21-24, screening can be based on patient choice and/or where women may benefit based on risk (i.e.: mulitiple sexual partners, no HPV vaccination, early teen sexual encounter, smoking).
Females under 21 should NOT be screened.
Once I start screening Paps, how often should I get them?
For asymptomatic women from age 25-69 who are or have been sexually active, Pap tests are recommended only every 3 years.
When can I stop getting routine Paps?
If you are 69 years of age or older, and have had 3 negative screening tests, you can discontinue screening. Yay! You're done!
If you haven't had 3 negative screening tests, then we recommend initiating or continuing screening until the recommended guidelines are met.
I've had a hysterectomy and my cervix has been removed for Benign Disease. Do I still need a Pap?
No! You can discontinue screening.
I've had a hysterectomy, but my cervix has not been removed. Do I still need a Pap?
Yes. Continue screening as per guidelines.
These guidelines are, of course, applicable to the average risk woman. There are always exceptions and individual cases that are more complex. Moreover, women with abnormal results have guidelines applicable to their results, which should be reviewed with a physician. If you have any questions or concerns, discuss your ideal screening timeline with your family physician.
Read the news story on the changes to the screening guidelines published in The Globe and Mail