A
pelvic examination is an important part of preventive
health care for all adult women and is part of a woman's regular physical
checkup. A pelvic examination is done to help detect certain cancers in their
early stages, infections,
sexually transmitted diseases, or other reproductive
system problems.
A
Pap test is the most effective screening test for
cervical cancer and is often part of a pelvic exam.
The Pap test screening schedule is based on age and risk
factors.1, 2 Testing should
start 3 years from the time you begin to have sexual intercourse, but no later
than age 21. You should have Pap tests every 1 to 3 years. Studies show that
healthy women who have normal Pap tests for 3 years in a row are unlikely to
develop moderate to severe cervical cell changes within 3 years. Discuss this
with your health professional to determine whether you can safely extend your
Pap test screening to every 2 to 3 years.3 After ages
65 to 70, experts agree that if you have had three normal Pap test results in
the past 10 years, you may decide to stop Pap test screening. You and your
doctor can decide on the appropriate age to stop based on your medical
history.4
Women who have gone through menopause have an increased risk of
false-positive Pap test results. For this reason, postmenopausal women with
previous normal Pap tests may be advised to have Pap tests less frequently than
every year.5
Human papillomavirus (HPV) testing is done to identify
high-risk types of HPV infection. HPV testing may be done at the same time as a
Pap test in women older than 30 because HPV high-risk types are more likely to
persist in these women. If you had an abnormal Pap test result that was caused by HPV, knowing
which type of HPV you have can help guide your treatment decisions. Many women
with high-risk types of HPV infection do not have cervical cell changes that
progress to more severe cell changes, such as cancer.
Some new testing methods, such as
AutoCyte-Screen (computer-automated review of Pap
smears) and
liquid-based collection are being used in many areas
of the United States. Liquid-based collection methods allow testing for human
papillomavirus (HPV) at the same time as a Pap test, but these methods are not
available everywhere and may be more costly.
Studies have shown that women who are overweight or obese are less
likely to have regular Pap test screening and therefore may be at higher risk
for undetected cervical cell changes. It is important for every woman to have
regular gynecologic exams.
The terms used to report Pap test results vary depending on which
classification system is used. The Bethesda system (TBS) is used by most labs
in North America. Other classification systems are used around the world. For
more information on testing, see:
Schroeder BM (2003). ACS updates guideline for the
early detection of cervical neoplasia and cancer. American
Family Physician, 67(9): 2011–2016.
Waxman AG (2003). Cervical cytology screening.
Obstetrics and Gynecology, 102(2): 417–427.
Sawaya GF, et al. (2003). Risk of cervical cancer
associated with extending the interval between cervical-cancer screenings.
New England Journal of Medicine, 349(16):
1501–1509.
U.S. Preventive Services Task Force (2003). Screening
for cervical cancer: Summary of recommendations. Available online:
http://www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.pdf.
Sawaya GF, et al. (2000). The positive predictive value
of cervical smears in previously screened postmenopausal women: The Heart and
Estrogen/progestin Replacement Study (HERS). Annals of Internal
Medicine, 133(12): 942–950.
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information. For more information, click here.
