Friday, January 11, 2013

The "annual pap exam" should be a relic

Early in 2012, I took myself to get my pap smear for the first time since moving here.  It was normal.  Yesterday, in the mail, I got a postcard reminding me that I was due for my "annual exam."  This postcard made me most unhappy.

In 2009, the American College of Obstetrics and Gynecology (ACOG) and The United States Preventive Service Task Force (USPSTF) advised docs that yearly screening for pap smears is unnecessary. (1) These recommendations were updated in 2012 to advise that pap smears every 3 years are sufficient to screen for cervical cancer. (2)

These changes are based on sound science.  The overwhelming majority of cervical cancer is caused by the Human Papilloma Virus (HPV).  Pretty much everyone who has sex will, at some point, be infected by this virus.(3) Most people's immune systems clear out the virus before it can damage any cells, though, which is one reason cervical cancer is rare despite HPV's ubiquity.  

Cervical cancer is an extremely slow-growing cancer, which is why the experts now recommend screening just every 3 years. (2)  Heck, if you're over thirty and the doc checks for HPV along with your pap and both are negative - voila! - you get a 5 year pass.

So, what do I do about this postcard?  I don't need another pap smear until 2015.*  There is no evidence-based reason to have a pelvic exam in the interim.  I am not overdue for any other health care needs.

My options at this point seem to be:

1. Ignore the card.  
2. Call the office and say, politely, that I actually don't need another pap smear until 2015.
3. Mail the postcard back along with a copy of the current ACOG and USPSTF guidelines.

In general, I prefer the direct approach, which makes option 1 (passive) and option 3 (passive-aggressive) distasteful.  On the other hand, I'm still pretty new in town, and it's not that big of a town, so I am fearful of igniting trouble with option 2.

I liked this office and doc when I went there, and I don't want to appear impertinent.  I should be willing to hear their side of things.  But science is science, and I want to share my side, too.  Which is that I will not, under any circumstances, submit to another pap smear before 2015.

Hand me the phone.

* I should have insisted on getting the HPV testing, too, and then it'd be 2017, but I was trying not to be a typical doctor-patient...


  1. Dr. M-

    I haven't seen ANY GYNs in the area following the q3-5 yr window either. Very confused why not since it is an ACOG recommendation too! I am happily educating my patients who get their GYN care with me!


  2. Thanks for reading and commenting, EFord! I confess that my dark side is having trouble not following option 3. ;) But it is a good opportunity for Family Med to lead the way on this issue locally...