What do you mean I don’t need a pap this year?
One of the biggest changes that happened in women’s health in the last few years was in 2010 when the pap smear guidelines were updated to reflect a more conservative management system and the benefits of HPV testing. For women under 30, the annual pap was kept (though some advocate for every 3 days), but women over thirty were recommended to have a pap alone every 3 years or a pap and HPV test every 5 years. There are some restrictions - no recent abnormals and no one at high risk for dysplasia.
Why the change? Stingy insurance? Stingy government? Actually no. Better technology. In the 1960s when Dr. Papanicolau developed one of the best and IMO one of the most important screening tests of all time, a pap smear was literally a smear. You used a brush, smeared it on one slide, sprayed some fixative (or hairspray if that’s what you had) and sent it to the lab. These days, we are using cervical cytology - though we often still call it a pap smear. This is the little bottles you may see these days. It generates the equivalent of a hundred plus slides and is much more accurate. Instead of picking up 60% of abnormalities, it can pick up >90% of abnormalities. When combined with HPV testing, it makes the accuracy >99%. With that kind of improvement in technology and because Cervical dysplasia takes many years to form, its ok for low risk women to spread their pap smears out.
The way the guidelines are written, low risk women get shunted into less frequent screening. Anyone with a positive HPV test or any abnormality on the pap gets a little extra attention. The important thing to know about HPV is that somewhere around 70+% of women who have been sexually active have been exposed to HPV. Most women clear it and never have a problem. If you immune system takes a hit, your a smoker or have some other predisposition though, HPV can get active and causes about 99% of cervical cancers. We don’t have any good treatments other than taking good care of your health, but vaccination is our best defence. Recommended at aget 12 - prior to the onset of sexual activity, its a 2 or 3 dose series that is well tolerated and decreases the incidence of cervical dysplasia and almsot certainly cervical cancer.
The jist of the story - if you follow the pap guidelines and get regular screening, your chances of getting cervical cancer are about 0%. Prior to adding HPV testing, I’d have said 0.5% for people who get regular screening, but following the current guidelines, I’ve never seen anyone following the guidelines proceed to a cervical cancer.