Cervical Cancer Guidelines Leaves Women Confused About Annual Pelvic Exams

There is good news and bad news in the world of women’s health.

The good news is that women do not need annual Pap smears. The bad news is that, upon hearing the good news, many women incorrectly assume they no longer need annual pelvic exams, either.

Historically, Pap smears were performed annually, and during the same time as pelvic exams, so it is understandable why women would conflate the two. But these exams are different, and it is important that women continue to undergo annual pelvic exams every year, starting at the age of 21.

Pap smears involve gently scraping cells from the cervix. The cells are then observed under a microscope for abnormalities that might indicate precancer or cancer. Many Pap tests now include testing for human papillomavirus, or HPV, the virus that causes cervical cancer. Pelvic exams, meanwhile, are an internal and external examination of the pelvic organs. During these exams, a woman’s doctor will check for signs of ovarian cysts, sexually transmitted infections, uterine fibroids, vulvar or vaginal conditions, as well as palpating the bladder and sometimes the rectum.

Pap screening has dramatically reduced the rates of cervical cancer in the U.S. and other developed countries. However, we have recognized that we can maintain the same level of protection with far fewer Pap tests. In fact, just five Pap tests during a woman’s lifetime can reduce the risk of cervical cancer by almost 75 percent.

That is why in 2018, the American College of Obstetrics and Gynecology (ACOG) issued new guidelines, suggesting that women ages 21 to 29 should have a Pap test every three years, while women ages 30 to 65 are advised to undergo a Pap test and HPV test every five years. Adhering to these guidelines reduces the risk of cervical cancer by almost 95 percent.

When I tell women this, they are understandably happy – few people want to undergo an uncomfortable procedure if they don’t have to. But many women are also concerned. The most common question I hear is, “If I’m only being tested every five years, how do you know I’m not going to get cancer in that time?”

There are two answers to this. The first is that we have very good data to show that even if you contract HPV the day after your Pap test, it would take (on average) five or more years for a significant lesion to develop. The second goes back to that pelvic exam. Every year, when your doctor sees you, she’ll examine you with her eyes and her hands. If something looks or feels concerning, she can order a Pap or take a biopsy.

There is a third answer to the cervical cancer question that doesn’t have anything to do with Pap smears or pelvic exams. Since the HPV vaccine was introduced in 2006, cervical cancer rates and precancerous lesions have been declining. We can vaccinate against cancer, a fact that is truly amazing. As more people are vaccinated, we hope to see the rate of HPV-related cancers decline even further.

This month is cervical cancer awareness month, and I hope that in addition to being aware of the disease, women are aware of what they can do to prevent it: Vaccinate against HPV, undergo a Pap smear every three to five years, and see your doctor for a pelvic exam – every year.

Lisa N. Abaid is a gynecologic oncologist and co-director, Hoag Breast & Ovarian Cancer Prevention Program, Hoag Memorial Hospital Presbyterian, Newport Beach, CA.

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