Many Women May Not Need a Pap Test Every Year
"I wouldn't ever not go and have a Pap," says Quakenbush, who has a 6-year-old daughter. "The fear of cancer is too real for me."
But Quakenbush may be worrying without reason, and she may not need to have an annual Pap test, since she has a history of normal results, suggests a University of California researcher who studied the rate of serious cervical problems in women who had regular Pap smears.
The rate of cervical cancer has declined dramatically in the past 50 years. More women used to die from cervical cancer than any other kind of cancer; now it ranks behind lung and breast cancer and is the 15th most common cause of cancer death. Much of the success in reducing cervical cancer is due to widespread use of the Pap smear, which can detect abnormal cell growth. Precancerous cell growth can be treated before it develops into cervical cancer.
The American Academy of Obstetrics and Gynecology and other professional associations recommend that women undergo annual Pap smears. But, as with mammograms and other preventive procedures, the necessity of annual Paps has come under scrutiny.
In this new study, George Sawaya, MD, and his colleagues at the University of California, San Francisco, looked at medical information for nearly 125,000 women who had a normal Pap smear to see how many developed an abnormal result up to three years after their last normal test.
They found that the same numbers of more serious problems occurred regardless of how many years had passed between Pap tests, although women who went two or more years between Paps had a higher incidence of mild problems. Mildly abnormal test results usually turn out to be false alarms, but women are generally subjected to additional tests -- and worry -- before the true results are known, Sawaya says.
"This is one of the first studies to show what the benefits are of frequent screening, and they are quite small," Sawaya tells WebMD. "It is always important for us to realize that in the U.S., the majority of cases of cervical cancer occur in women who have never had a Pap smear. It is unusual for women to develop cancer after a negative Pap smear." Sawaya is an assistant professor in the department of obstetrics, gynecology, and reproductive sciences at UCSF. The study appears in the journal Obstetrics and Gynecology.
When women see their gynecologists for their annual exams, he says, they should discuss the possibility of going more than a year between Pap tests. "I think we should not get into ruts," he says. "It is really time for us to sit back and consider what it means to provide well-woman care. It might not be annual screening for cervical cancer. It might be screening for depression, or domestic violence, or seat belt use."