Choosing Wisely is an initiative by the ABIM Foundation to identify commonly-used tests or procedures whose necessity should be questioned and discussed. This information was developed by Consumer Reports in cooperation with the American Academy of Family Physicians.
It’s important for women to get regular Pap tests, which check for abnormal cells in the cervix that might lead to cervical cancer. But many teenage girls and some women have the test when they don’t need it. Here’s why.
Pap tests usually don’t help low-risk women
Cervical cancer is rare in women younger than 21, even if they’re sexually active. Plus, abnormal cells found in these younger women usually return to normal, making follow-up treatment unnecessary and possibly harmful. Similarly, cervical cancer rarely occurs in women older than 65 who have had regular Pap tests with normal results. Continued testing doesn’t help them but can produce misleading results that lead to unnecessary treatments. And Pap tests aren’t useful for women of any age who have had their cervix removed during a hysterectomy and have no history of cervical cancer or pre-cancer.
The tests can pose risks
A Pap test can be uncomfortable and cause temporary bleeding. And when overused it’s more likely to spot abnormalities that would go away
on their own. Yet those findings often cause anxiety and prompt repeat Pap tests and procedures. For example, abnormal results can sometimes trigger a test called colposcopy, in which doctors take tissue samples, that can cause bleeding, cramping, discharge, and infection.
The tests can be a waste of money
A Pap test with a pelvic exam costs $150 to $250 or more, according to HealthcareBlueBook.com, and lab fees may be extra. If an abnormality is found, you might pay $350 for a colposcopy plus lab charges for a biopsy.
When should I have a Pap test?
The advice differs depending on your age:
- Women ages 21 to 65, including those who still have a cervix after a hysterectomy, should get regular Pap tests. However, having the test once every three years works as well as having it annually, since cervical cancer generally takes 10 to 20 years to develop. In addition, getting the test every three years can cut the number of follow-up tests.
- Women ages 30 to 65 can go five years between Pap tests if they combine it with a test for the human papillomavirus (HPV), a sexually transmitted infection that can cause cervical cancer.
- Women older than 65 who have had several normal Pap tests can stop having the test.
- Any woman with risk factors for cervical cancer — including a history of the disease or precancerous changes, or a compromised immune system —should be tested as recommended by her doctor.
Consumer Reports' Advice
How can you protect yourself against cervical cancer?
Get vaccinated against HPV.
Girls age 11 or 12 should consider the vaccine, which is given in three shots and protects against human papillomavirus, an infection linked to cervical cancer. So should females ages 13 to 26 if they weren’t previously vaccinated. But women who get the shot still need regular Pap tests because the shots don’t protect against all cancer-causing types of HPV. Boys could also consider the vaccine. That can help protect them from contracting HPV, and from transmitting it to future sexual partners.
Limit your sexual partners.
The fewer partners you have, the lower your risk of infection.
They can reduce the risk of HPV, and men who use them are less likely to be infected. But the virus, which is transmitted through skin-to-skin contact, can still infect uncovered areas.
Use spermicidal gels.
They can also help protect against HPV.
Smoking cigarettes and breathing in second-hand smoke increase the risk of cervical cancer.
Make your Pap test as accurate as possible.
Schedule your appointment for at least five days after your menstrual period stops. Avoid sexual intercourse, douches, tampons, birth control foams or gels, vaginal creams, moisturizers or lubricants, or vaginal medicines for 48 hours before the test.
How often do you get a Pap test? Has your doctor said it's necessary for you? Share your experiences in the comments section below.