Pap Smear (cont.)
In this Article
When should women start and stop having Pap smears, and how often should Pap
smears be performed?
The table summarizes the consensus of all the major
organizations regarding these important questions. The key points of the table
are as follows:
- All the guidelines agree that Pap smears should be started
within 3 years of first sexual activity or age 21, whichever comes first.
- There
are minor differences in the recommendations for the frequency and age at which
to stop Pap smears.
- Older women who have had many normal Pap smears in a row and
have been regularly screened are highly unlikely to have an abnormal Pap smear.
These findings point to stopping Pap smears in older women, as reflected by
several of the guidelines in the Table.
- Women who have had a total hysterectomy
for a benign condition no longer have a cervix, and thus do not derive any
benefit from screening for cervical cancer.
- In contrast, women who have had a subtotal hysterectomy still
have a cervix, and thus should be screened according to the recommendations of women
who have not had a hysterectomy.
- Women who have had a hysterectomy for abnormal
Pap smears have their own special recommendations.
Special situations may impact the frequency of screening. For example, women who have had cervical cancer, exposure to diethylstilbestrol, or a compromised immune
system (as with HIV infection, for example) should continue annual screening as
long as they are in reasonably good health. Women who have had a hysterectomy
for CIN2 or CIN3 (a type of abnormal Pap smear) should be screened until they
have had three normal Pap smears, (and if no abnormal Paps show up in 10 years, they
can stop having Pap tests).
What is the current status of the newer Pap smear technologies?
New technologies have been developed to try to circumvent the problem of
false-negative Pap smears. False-negative results occur when a disease or
condition is present but the test does not detect it. False-negative Pap smears
(slides with abnormal cells judged to be "normal") are estimated to be between
5% and 30%.
The new techniques consist of alternative ways to prepare and read Pap smears.
In one new preparation method known as liquid-based cytology, cervical cells are obtained as usual but a new
technique is used to prepare the slides for analysis. The physician puts the
cell sample into a vial of liquid preservative. The cells are then sent to the
laboratory where they are filtered and spread on glass slides. This method
removes any contamination from blood or mucous.
Prepared slides are usually read by cytotechnologists who examine thousands of
slides under a microscope every day. This exhausting process may be subject to
human error. Computer systems are now being developed to assist by providing an
automated analysis of slides. Slides containing abnormally appearing cervical
cells can first be automatically identified and then subjected to a second,
manual re-screening.
Recent guidelines are conflicting as to whether to recommend the new
technologies because sound scientific research is not available on which to base
a thoughtful recommendation. Besides being more expensive, the underlying
problem is that the new technologies (such as liquid-based cytology) have never
been proven to decrease mortality from cervical cancer as compared to
conventional Pap testing. In addition, even if future research shows that more
cases of cervical cancer are detected with the new technologies versus the
conventional Pap testing, there may be too many "false positive" cases in which
women are labeled to have abnormal Pap smears when they are perfectly normal.
This last point is critical. The information must be gathered before rational
recommendations can be widely instituted.
Next: With Pap smears so available, why are women still dying of cervical cancer? »
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