Six Things You Should Know About Your Pap Test

Focused on Health - January 2009

By Rachel Winters

For many women, their annual Pap test is not something to look forward to. While the procedure is relatively simple and painless, putting your legs in stirrups can certainly be a bit awkward; the speculum used to collect cell samples from your cervix can be a bit on the chilly side; and the gown you wear during the procedure may not offer much in the way of coverage…or fashion. 

While the Pap test comes with little embarrassments that can make even the most composed patient blush, it also comes with the potential to make a huge difference in the lives of women everywhere. The Pap test detects abnormal cell changes, called dysplasia, which, if untreated, may lead to cervical cancer.

Here, with the guidance of Andrea Milbourne, M.D., associate professor in M. D. Anderson’s Department of Gynecologic Oncology, we explore six things you should know about this important test.

1. Increased sexual activity equals increased need for a Pap test.

A woman’s level of sexual activity is a private and personal choice. What women should know, regardless of their sexual lifestyle, is that increased sexual activity leads to an increased risk for acquiring the human papillomavirus (HPV). While HPV can be harmless, it also can cause cervical cancer by changing normal cells in the cervix into dysplasia. If dysplasia is found and treated early, cervical cancer may be prevented.

Because condoms do not provide 100% protection against HPV, women who are sexually active and not in a monogamous relationship need to be even more vigilant about following cervical cancer screening guidelines.

“By the time most women enter college, 70% of them have had at least three sexual partners,” Milbourne says. “Your chances of getting HPV relates to the number of sexual partners you’ve had in the same way that driving on a busy road increases your chances of getting into a car accident. The more cars on the road, the higher percentage of risk you have. For sexually active women, getting a regular Pap test is essential.”

2. The HPV vaccine is a supplement to your Pap test, not a replacement.

Getting the HPV vaccine, or encouraging young women in your family to consider it, is a great first step toward cervical cancer prevention. That being said, the vaccine is in no way a substitute for the Pap test.

“The vaccine may give women a false sense of security,” Milbourne says. “And because getting a Pap test is not what most women consider a favorite activity, getting the vaccine might cause them to put off making an appointment for their next Pap test.”

Because the HPV vaccine does not protect against all types of HPV, or other sexually transmitted diseases, it cannot be your only method of cervical cancer prevention. Women also should remember that cervical cancer doesn’t have many obvious symptoms, which makes the Pap test significantly important in preventing cervical cancer.

 3. You can afford a Pap test.

“Without health insurance or access to affordable health care, a Pap test can be costly,” Milbourne says. “I’m concerned because, as times get worse economically and people lose their jobs and insurance, preventive measures, such as the HPV and Pap tests, will be one of the first things to go out the window.”

If you can’t afford a Pap test, there may be places in your community where you can get one for free or at a reduced cost. For information on where to get a free or low-cost Pap test, call the National Cancer Institute’s Cancer Information Service at 1-800-4-CANCER.

Pap tests also are sometimes covered by Medicaid and are covered every two years by Medicare or every year for certain women at higher risk. For more information, call 1-800-MEDICARE.

4. You have to prepare for an upcoming Pap test.

Here are a few tips to help you get more accurate Pap test results:

• Do not douche 48 hours before your appointment
• Avoid using vaginal medicines, spermicidal foams, creams or jellies 48 hours before your appointment
• Do not have sexual intercourse 48 hours before your appointment
• Reschedule your Pap test appointment if you have an unexpected heavy menstrual flow on the day of your exam

“Lubricants, spermicides, douching and sexual activity can interfere with the interpretation of Pap test results, potentially leading to false results or the need for repeat tests,” Milbourne says.

To listen to some commonly asked questions about the Pap test, visit the multimedia box on the right-hand side of the page.

5. You are never too old to get a Pap test.

There are a lot of benefits that come with being over age 65: riding the bus for free; discounted movie tickets; and reduced museum fees. Of all the benefits that might come with growing older, skipping your regular Pap test, if you’re a sexually active woman over age 65, is not one of them.

As female life expectancy gets longer, many women continue to enjoy sexually active lifestyles throughout their sixties and into their seventies. It has been well established that cervical dysplasia and cancer are mostly caused by the sexually transmitted disease, HPV.

“For women over age 65, cervical cancer is rare, but it does happen,” Milbourne says. “If you are over age 65, sexually active and not in a monogamous relationship, you should continue your annual Pap test, as you are still susceptible to HPV, which can cause cervical cancer.”

Women over age 65 who have had three or more normal Pap tests in a row, no abnormal Pap tests in the past 10 years, and who are either no longer sexually active or in a monogamous relationship, should talk to their health care provider about being screened less often.

6. Before the Pap test was developed, cervical cancer was a leading cause of cancer death in American women.

The American Cancer Society estimates that about 3,870 women died from cervical cancer in the United States during 2008. This number is low compared to annual statistics for other more common cancer types, such as breast or lung cancer, but what most people don’t know is that cervical cancer was once one of the most common causes of cancer death in American women.

Why the change? Thanks to the Pap test, between 1955 and 1992, the cervical cancer death rate declined by 74%. As the Pap test became a standard test for American women, doctors were able to find abnormal changes in the cervix before cancer developed.

While the cervical cancer death rate continues to decline in the United States, women in countries where Pap tests are not as readily available or affordable still face the challenges shared by American women more than 50 years ago.

“In some countries, due to a lack of resources, women are only tested every five years, if at all,” Milbourne says.

Cervical cancer is the second largest cause of female cancer deaths worldwide, according to the World Health Organization, with 288,000 deaths each year. About 510,000 cases of cervical cancer are reported each year – nearly 80% of which occur in developing countries.