Our Bodies, Our Lives
By Dr. Tristi Muir
The musical “Evita” depicts the true story of Eva Perón, who rose from an illegitimate birth to become the passionate “spiritual leader of Argentina.”
During her lifetime, she promoted labor rights, championed women’s right to vote in Argentina, established a foundation to help the poor and won the hearts of a nation.
As Eva was riding this wave of political momentum, she was diagnosed with advanced cervical cancer and died at the young age of 33.
Can you imagine how much more she could have accomplished if Pap smears were available? Unfortunately, the tests were just being introduced in the United States at the time of her death in the early ’50s.
Cervical cancer once was the No. 1 cancer in women. After the introduction of Pap smears, cervical cancer rates in women in the United States fell to No. 14.
Even today, screening is not available in many developing countries, and in those countries, cervical cancer remains the leading cause of cancer death in women.
The Pap smear is a very effective screening tool that has saved the lives of millions of women.
So why are doctors decreasing the frequency of Pap smears?
Virtually all of cervical cancer is caused by a virus — the human papillomavirus, more commonly known as HPV. There are many types of HPV, but 70 percent of cervical cancer worldwide has been linked to HPV-16 and HPV-18.
This sexually transmitted virus is very common and fortunately goes away without treatment in most women. Research studies have shown that there is no advantage to having annual Pap smears for most women compared to Pap smears performed every three years.
Annual Pap smears have been linked to overtreatment of cervical dysplasia (abnormalities in the cells of the cervix) that would have gone away on its own.
As of September 2013, the American Congress of Obstetricians and Gynecologists recommends the following:
Cervical cancer screening should start at age 21.
Women 21-29 years should get a Pap smear every three years.
Women 30-65 years should get a Pap smear and an HPV test (co-testing) every five years (preferred). It is acceptable to have a Pap test alone every 3 years.
Women should stop having cervical cancer screening after age 65 if they do not have a history of moderate or severe dysplasia or cervical cancer and they have had either three negative.
Pap test results in a row or two negative co-test results in a row within the past 10 years, with the most recent test performed within the past five years.
Women with prior hysterectomy do not require a Pap smear if they have not had a history of cervical cancer or moderate or severe dysplasia. Women with a supracervical hysterectomy (cervix remains but the body of the uterus is removed) still require screening.
There are a couple of exceptions to these guidelines:
Women who have a history of cervical cancer, are infected with HIV, have a weakened immune system or who were exposed to diethylstilbestrol (DES) before birth should not follow these routine guidelines.
Women with abnormal Pap smear results might require more frequent testing or treatment.
Even though the Pap smear is no longer an annual ritual for most women, an annual gynecologic visit is recommended.
Gynecologists do so much more than “just a Pap.” Evaluation for pelvic health — incontinence, pelvic pain, period irregularities, contraception or conception education, prevention of (or testing for) sexually transmitted infections (including HPV), hormone therapy and breast health are addressed.
Our Bodies, Our Lives focuses on issues surrounding women’s sexual, gynecological and emotional health. Dr. Tristi Muir is the director of the UTMB Pelvic Health and Continence Center at Victory Lakes. Visit www.utmbhealth.com/pelvichealth.