Pap tests

When you need them—and when you don't

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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 Paps 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 pre-cancerous changes, or a compromised immune system—should be tested as recommended by her doctor.

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Published by Consumer Reports © 2012 Consumers Union of U.S., Inc., 101 Truman Ave., Yonkers, NY 10703-1057. Developed in cooperation with AAFP. Portions are derived from AAFP's “Five Things Physicians and Patients Should Question” list. © 2012 AAFP. This list is based on the “The ‘Top 5’ Lists in Primary Care: Meeting the Responsibility of Professionalism,” the Good Stewardship Working Group, Arch Intern Med. 2011;171:1385-1390. “Top 5” Lists in Primary Care were first published as part of the Less is More™ series in the Archives of Internal Medicine. ©2011 American Medical Association.

05/2012