Q: I’m 32, happily married and the mother of a 3-year-old. My doctor said I don’t need a pap smear this year. Is it really okay to skip it?
A: Yes. The dictum that you must get an annual pap smear doesn’t apply to women at low risk for cervical cancer, which a pap smear detects.
We know now that cervical cancer is almost always the result of a sexually transmitted disease (STD). If you and your husband are mutually monogamous — and have been for a number of years — the chances that you will catch a sexually-transmitted disease is remote. (I say “remote” on the slim chance you are harboring a virus from the distant past.)
The STD that causes cervical cancer is human papilloma virus (HPV), of which there are more than 30 types.
This virus is very contagious. Remember: When a woman has sex, she can become infected with all the microbes and viruses of her partner — and all the partner’s partners, and on and on into the viral past.
Currently, an estimated 70 percent of sexually-active young adults harbor one of the HPV viruses. Thankfully, only a few are likely to enter the DNA of cervical cells, causing mutations and precancerous changes.
Over time, most women will clear an HPV infection on their own. But those who smoke and/or take steroids — or keep getting re-infected — are less likely to become free of the virus.
It usually takes three years for HPV to cause cancer. So, for women at low risk, a thorough pap smear every three years will suffice to catch any dangerous changes
Low-risk means that you and your partner are monogamous, that you have had yearly pap smears until now, and that none have shown pre-cancer or cancer.
Low-risk also means you are not HIV-positive, were not exposed to DES during your mother’s pregnancy and are not taking steroids or chemotherapy. (DES was a hormone often prescribed for pregnant women in the 1950s and early 1960s.)
The new guidelines, which account for age and risk, are based on recommendations by The American Cancer Society and The American College of Obstetricians and Gynecologists.
Below 21: Young women should have a pap smear every year, beginning three years after the onset of intercourse and no later than 21. (If pap smears are done too early or often, some changes that would reverse on their own would be found, leading to costly tests and unnecessary worry.)
Between 21 and 30: Women should have a pap smear yearly.
Over age 30: Women should have a pap smear every two to three years, if the previous three paps were all normal.
After age 70: Women can stop having pap smears if the paps have been normal in the last 10 years.
After a hysterectomy: Women can stop having pap smears if the surgery was performed for benign disease and the cervix was removed.
In addition, there is a test that can detect HPV when you have a pap smear. Most doctors are confident that, if both of these tests are negative, you go pap-free (and worry-free) for three years.
Dr. Reichman’s Bottom Line: Old recommendations change based on new knowledge. For women at low risk for cervical cancer, getting a pap every two to three years is acceptable. You should not, however, skip your annual body, breast and pelvic exams.
Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You willl find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," published by William Morrow, a division of .
PLEASE NOTE: The information in this column should not be construed as providing specific medical advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician.