Pap tests are a super important part of a woman’s health screening. It’s a test that checks for changes in the cells of the cervix that indicate the development of cervical cancer. Yes, I said the scary “C” word. This is not a test you want to skip out on. That being said, they are not the most fun test a lady can do at the doctor’s office.
So, with that in mind, when should you have a Pap done? How often do you need one? To understand the timeline recommendations, you need to understand a bit about cervical cancer first.
Most cervical cancers develop from certain strains of a virus called HPV (Human Papillomavirus). There are over 100 strains of this virus; some strains are low risk and cause genital warts, and some unfortunately cause cancer. HPV is spread through skin-to-skin contact, specifically sexual contact whether that be oral, anal or genital. It’s an STI (sexually transmitted infection) and a lot of people have it – Over 75% of sexually active Canadians, actually, and the highest rates of infection occur in young people aged 15 to 24.
Cervical cancer is a slow growing cancer. It can take years for cervical cells to go from healthy normal cells to what we in medical world call CIN lesions (early dysplasia changes and there are different types) to full blown malignant cancer cells. This is a good thing. It means that if you get screened regularly, you can catch the cell changes in an extremely early stage and deal with them without ever hearing that horrible “C” diagnosis!
So, if cervical cancer is slow growing, when do I need a Pap?
The Canadian Task Force for Preventative Health’s (the body that creates best practise guidelines for doctors) most recent 2013 guideline recommends this:
- For women aged < 20 we recommend not routinely screening for cervical cancer
- For women aged 20 to 24 we recommend not routinely screening for cervical cancer.
This is surprising isn’t it? These recommendations come not only from the research looking at average age of diagnosis, but also from a cost-benefit point of view. Cervical cancer is most often diagnosed in ladies over 25, with the bulk of cases being found in ladies in their 50s. Looking at the cost of the test on the health care system (and on ladies) and the growth nature of the cancer it’s checking for, waiting to screen until you are older makes sense.
There are small caveats to this thinking that we use here at Rooted and those are: If you are sexually active, if you have a family history of cervical cancer, and especially if you are changing sex partners frequently, you should do a Pap test even if you fall into these age groups. Recommendations like the above are based on the general population. You could be the special lady that develops a problem early at 23 years old. Nobody wants to be that special, so it’s worth it to test.
What about ladies over 25?
The Task Force says:
- For women aged 25 to 29 we recommend routine screening for cervical cancer every 3 years.
- For women aged 30 to 69 we recommend routine screening for cervical cancer every 3 years.
- For women aged ≥ 70 who have been adequately screened (i.e., 3 successive negative Pap tests in the last 10 years), we recommend that routine screening may cease. For women aged 70 or over who have not been adequately screened we recommend continued screening until 3 negative test results have been obtained.
As they mention on their website, these guidelines “do not apply to women with symptoms of cervical cancer, previous abnormal screening results (until they have been cleared to resume normal screening), those who do not have a cervix (due to hysterectomy), or who are immunosuppressed.”
What about if you’ve had an abnormal test?
First, don’t freak out. “Abnormal” does not automatically mean cancer. You will need to go for further testing with a gynaecologist, and possibly receive treatment based on what they find.
After that, you will most likely be told you need to get yearly Pap tests to make sure everything stays normal. Once you get a series of normal Paps, the doctor might clear you to go back to the guideline recommendations.
What if it is cancer?
If you should hear that cancer diagnosis, the awesome news is that cervical cancer is very treatable and mortality rates are very low. This would be a great time to check in with your ND and see what you could be doing to help with treatment and keeping it gone forever. Really, the most advanced cervical cancers that lead to mortality are found in those ladies who don’t get their bits checked out, so get yours checked out!
If you have any questions or are due for a Pap, send us an email or give us a call at Rooted. We run a Pap clinic every other month, you do not have to be a patient of the Rooted to use the clinic, and I’m sure we can fit you in!
Stay healthy ladies,
Dr. Sarah Kiss, ND
P.S.: To be clear, the Pap test does not test for HPV, only cell changes. Testing for HPV is a different test that you can ask your MD for along with the Pap if you are interested.