It’s Pap-apalooza!
Perhaps your first question is…What is a Papapalooza?! Well, you will just have to read through a bit to find out. In the meantime, we are reminding everyone that January is Cervical Health Awareness month. It is the time of year to figure out when your last Pap screening was done and if it’s time for another.
Many of us grew up referring to the pap as our “Annual Exam” because women used to be advised to have Pap screening every year by their health care providers. However, for the past decade the guidelines have not recommended routine yearly Pap screening.
Pap Tests or pap screens are done to check for cellular changes in the transformation zone of the cervix (the place where two types of cells meet). This is typically where cellular changes of cervical cancer occur first. However, when we do a Pap, we may also screen for the presence of high-risk HPV (human papilloma virus). There are many strains of HPV, some are associated with genital warts, and some are associated with increased risk of developing cervical cancer.
Less frequent screening was adopted in part because cervical cancer progresses very slowly, and in 93% of the time requires the presence of one of the high risk HPV strains. Current guidelines now consider HPV status when determining frequency of screening and management of pap results. In addition, Pap and HPV screening for women under age 25 may cause more harm than good.
If exposed to HPV, most young people will clear HPV from their system on their own by age 30. More frequent testing has the possibility of over-treatment which can impact pregnancy and birth. Finally, most cases of cervical cancer are present in midlife (age-35-50), in women who have not had regular screening or did not follow up with management guidelines after an abnormal pap.
These are the most current screening guidelines according to the American Cancer Society’s Guidelines from 2021:
- Women under the age of 25: NO Paps and NO HPV screening, “HPV is very common in women younger than age 30. Since most HPV that is found in these women will never cause them health problems, it is not useful to test young women for HPV. Most young women will fight off HPV within a few years,” according to the CDC.
- Women 25-65 years old: Those aged 25 to 65 should have a primary HPV test* every 5 years. If primary HPV testing is not available, screening may be done with either a co-test that combines an HPV test with a Papanicolaou (Pap) test every 5 years or a Pap test alone every 3 years. (*A primary HPV test is an HPV test that is done by itself for screening. The US Food and Drug Administration has approved certain tests to be primary HPV tests.)
- Women who are over 65 years old: NO paps or HPV screening, IF they have had normal paps for the previous 10 years and no pap with serious pre-cancerous cells for 25 years. Once stopped, it should not be started again.
Individual considerations:
- Women who have had a total hysterectomy (uterus and cervix removed): Stop screening, unless hysterectomy done as a cancer or pre-cancer treatment. You should consult your MD.
- Women who have had a hysterectomy without the removal of the cervix (called a supra-cervical hysterectomy): Screening according to age and risk guidelines above.
- Women who are high risk for cervical cancer because they have a suppressed immune system or were exposed to DES medication in utero: May need to be screened more often.
- Women who have been vaccinated for HPV: Should be screened according to their age and individual risk guidelines. The HPV vaccine does not protect against all strains of high-risk HPV. The CDC does not recommend routine HPV vaccination for women over age 26.
- Women who are HPV+: Should get pap + HPV screening yearly.
- Women with a history of abnormal pap screening: Should consult their midwife or physician to determine the screening interval or management that is best for their circumstances.
We provide Pap screening as part of our midwifery services when needed during pregnancy or postpartum, but we also offer Pap screening at any time in a woman’s life. You don’t need to have a baby at The California Birth Center in order to enjoy the benefits of Well Woman care with our midwives! Your mom, sister, or best friend can make an appointment for a Well Woman visit with Pap screen with us!
As a personal side note, we hear medical providers describe Pap Screens as preventative care. But remember, Pap screens are not technically “preventative care”, they are “early detection screening tools.” Preventative care is eating a whole food-rich diet, getting exercise in the fresh air, using tools for stress management, avoiding smoking and other high-risk behaviors, having a healthy relationship with your body and all its parts!
There will be some people who do all the “right things” and still develop cervical cancer because sometimes despite our best efforts we may have unexpected outcomes due to genetics or circumstances beyond our control. This is why we encourage people to get screened appropriately. Know that your midwives will help you navigate any abnormal results…or as is most common congratulate you on your healthy and lovely cervix!
So, in celebration of Cervical Health Awareness month and to make this health screening a little more enjoyable, we will have a “Pinot & Paps Papapalooza” event at The California Birth Center on January 26th 1:30-6:30pm! We will have an afternoon of pap screening with our lovely midwives. Complimentary beverages (sparkling cider & a taste of Pinot) and cheese & crackers will be served. Call or text 916-223-7731 to save your spot and join us for the afternoon!