Yes, it’s true: Not all women need a Pap smear

If you’ve ever had a Pap smear, you know that the experience of lying on a cold examining bed half-naked can be very unpleasant.

With your genital area exposed, a doctor inserts an instrument called a speculum in your vagina and scrapes off some cells from the cervix. These cells are sent to the laboratory to screen for the earliest sign of cervical cancer, the third leading cause of death in women.

Introduced 60 years ago, the Pap smear remains the mainstay when it comes to the early diagnosis of the disease.

If you are one of those women who have been putting off your doctor's visit because you dread the pap smear, the October 17, 2011 issue of the Annals of Internal Medicine suggests that women younger than 20 and older than 65 do not need a Pap smear.

A review of multiple studies and trials showed that there is no improvement in detecting cervical cancer for the mentioned age groups. In addition, the incidence of cancer in women under 20 is rare.

While it is true that the presence of Human Papilloma Virus (HPV) in young adults may increase their risk of developing cervical cancer, HPV infection is observed to regress spontaneously in 60 percent of cases in this set of women.

For women 65 years and older, Dr. Kimberly Vesco from the Center for Health Research at Kaiser Permanente Care Management Institute (KPCMI) suggests that they may do away with their regular pap smear once they've had three successive normal tests and/or no abnormal findings within the past 10 years.


Potential harm of screening
Dr. Vesco also said that for women who are at low risk for cervical cancer, evidence shows that “the potential harms of screening outweigh the benefits of cervical cancer screening..."

Reports show an increased risk of false-positive results leading to uncalled-for surgical procedures, unnecessary expenditure and the anguish and psychological trauma of patients being told they might have cancer.

In these instances, Dr. Vesco's team concludes that cervical cancer screening for these women may be more harmful.

Visit your OB/GYN
Women within the 20 to 65 age group still have to visit the doctor regularly.

Recommendations vary on the frequency of having a Pap smear.

KPCMI recommends screening every three years for asymptomatic, average-risk women.

The American College of Obstetricians and Gynecologists (ACOG) says women aged 21 to 29 should get a Pap smear every two years.

For those 30 years and above, it’s every three years but only if they meet the following criteria:

1.  Three consecutive normal Pap smears

2.  No history of abnormal smears in the past 10 years (i.e. Cervical Intraepithelial Neoplasia or CIN 2 and/or 3)

3.  No HIV infection

4.  Not on chemotherapy or other immunosuppressive treatment

5.  No exposure to the hormone diethylstilbestrol


If a woman finds herself saying “yes” to at least one of the risk factors listed above, she would have to undergo screening every year.


No-risk demographic
Among those who don’t need a Pap smear are:

1.  Women who have undergone a total hysterectomy for any benign gynecologic condition like fibroids or myoma.

2.  Women who have never had any sexual activity—not with a partner of either sex or by masturbating with the help of an inanimate sexual device or toy.

3.  Similarly, children, because they have had no sexual encounters, do not need a Pap smear. They have a very low risk of acquiring the HPV infection which is the precursor for cervical cancer 99 percent of the time.

But then, whatever age group you belong, it's always a good idea to see your doctor at least once a year.