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On Health

Cervical cancer was once the leading cause of death for women in the US. The dramatic reduction of deaths from this malignancy (only around 4,000 cases are estimated for all of 2014) is due to widespread use of the papanicolaou (Pap) smear, which is a way of sampling cervical cells with a brush or spatula and evaluating them under a microscope.

It is one of the great success stories in the field of preventive medicine. But screening methods and frequency have changed over the past few years. Test your current Pap smear knowledge with the quiz below.

1. True or false? Women/girls should start getting Pap smears if they start becoming sexually active in their teen years.

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False. Regular Pap smears start at age 21 even if girls/women become sexually active before then. In this age group, changes in the cervical cells can occur transiently and then revert to normal. So, testing only women 21 and over reduces the number of potentially unnecessary procedures done. However, sexually active women/girls under the age of 21 should still be routinely screened for STDs even though a Pap is not done.

2. True or false? Any time a woman has a pelvic exam, she is getting a Pap smear.

False. A pelvic exam can also be done to evaluate discharge, vaginal walls, cervix, and ovaries. Some women are not aware that they may not have had a Pap smear during their pelvic exam.

3. How often do I need a Pap, then, if I am over age 21?

For women over 21 and under 30, Paps are recommended every three years, with more frequent screening if there are atypical cells. For women over age 30, a Pap may include a “co-test” for human Papillomavirus (HPV), which is the leading cause of cervical cancer. If the HPV testing is negative, the next Pap would not be due for another 5 years.

4. True or False. Doctors screen for STDs when they do Pap smears.

Yes and no. HPV is sexually transmitted and it can be tested in the scenario noted above, for example. But tests for gonorrhea, chlamydia, HIV and syphilis are done separately. So, if you are in a new sexual relationship (even if you haven’t been in one since your divorce or since you’ve been widowed) or if you have multiple partners, ask about STD screening. Don’t assume an STD screening is being done.

5. When can I stop getting Paps?

Cervical cancer screening can stop at age 65 if there has been adequate prior screening. Also, if you’ve had your cervix removed during a hysterectomy which was done for benign conditions (nonmalignant uterine growths, for example), you no longer need to have a Pap smear.

Remember, these are general guidelines. There can be scenarios where these answers are different for certain individuals. Medicine is rarely one-size-fits all. Always ask your own doctor what is best for your health based on your own medical history.

Linda Pourmassina, M.D., is an internal-medicine physician who practices at The Polyclinic in Seattle. She has a blog at and can also be found on Facebook and on Twitter (@LindaP_MD).

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