If you’ve been with me for a while, you know I’m passionate about Pap smears.  (Yes, I know this statement would sound really strange proclaimed by anyone outside of women’s health.)  In my daily work, I run into many misconceptions about Pap smears.

So, today, let’s dive into a few of them.

The Pap smear is synonymous with a woman’s yearly exam.  In the office, I talk about pap smears an average of 27.8 times a day, for a total of 2h and 5 min per weekday.  Or perhaps, I spend my entire day talking about them.  I lose track.

I joke because somedays, I feel like ALL I do is talk about Pap smears. It is one of the topics my patients and I discuss frequently, because in the last 10 years, there have been many fundamental changes surrounding the rationale behind how often we do them and thus, there’s, understandably, a lot of confusion and many misconceptions.

This confusion stems from the fact that although our knowledge about the utility of the Pap smear has changed dramatically, this doesn’t always equate to how doctors practice or to how people think about their visit to the gynecologist.

I want everyone here to have a rock solid understanding of what a Pap does and what a Pap does not do.

All this to say, if you’re on the up and up with the 2012 and beyond guidelines, you can skip this entire note and jump on over to Facebook where we can chit chat about cute cat videos or period humor.

If you’re not, stick with me.

Did you know that most of us should not get yearly Pap Smears?  Now, I don’t mean to skip your annual exam with your favorite doctor for your favorite pelvic exam in those awesome stirrups. I mean, specifically, the part of that womanly ritual with a speculum and a special cervical swab.

Yearly Paps are so 1998.

There are exceptions, but for the vast majority of us, a yearly Pap has the usefulness of a monthly colonoscopy: it’s overkill, carries risks of over testing and doesn’t detect more of the devastating cancer it is meant to prevent.

Here’s how Pap’s work: Paps are intended to find PRE-cancer.

PRE-cancer of the cervix (not uterus, not ovaries, not elbows).

Pap smears detect cervical cancer precursors, years before they ever turn to cancer.  What we’ve realized is that cervical cancer is really, really slow to develop.  So, if you have a normal Pap smear, the chance of it becoming even mildly abnormal in the next 3-5 years, is really, really, really slim.

But, the chance of a Pap smear, done too frequently, showing us mild changes that are not associated with cancer, is high. In the past, we did Paps every year.  We also started doing them at really young ages. We frequently found mild changes on the cervix. We acted on those mild changes- because were were cancer warriors and we were going to stamp out cervical cancer. And by “act”, I mean, we did biopsies and surgeries on lots of women. And you know what we found?  More cancer? More lives saved?

Nope.

We found that we were doing unnecessary interventions. Unnecessary surgeries.

At the end of the day, we had a generation of women who experienced angst and medical procedures, but we didn’t find or prevent more cancer.  We found that we freaked people out, made them think they had a chance of having cancer caused by a sexually transmitted virus, and put them through office biopsies and surgeries in the operating room.

But ultimately, our frequent testing, unknowingly, did more harm than good.

I encourage you to read my 2 minute summary of the latest guidelines.

If you want a more in depth read, this post should do the trick.

Then, I would be ever so grateful, if you would share what you learned with a friend.  Perhaps more importantly, if your physician is still doing yearly Paps and you aren’t sure why, share what you learned with them and make sure you understand how often you need Pap smears