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Because most women in the United States have regular pap smears, cervical cancer is not nearly as common in this country as it used to be or as it is in countries where women do not have regular pap smears. When women are diagnosed with cervical cancer, it is usually in situations where they have not been screened with a pap smear for at least five years.

Beth Goldbaum, M.D., obstetrician and gynecologist at Mount Auburn Hospital in Cambridge, a teaching hospital of Harvard Medical School, says, “It is very important for women to have regular pap smears since this test is the only way we can prevent cancer of the cervix.”

A pap smear is a screening tool for cancer of the cervix, which is the narrow passage from the womb to the vagina. The pap smear is part of a normal gynecologic exam where a medical instrument called a speculum is inserted in the vagina to hold it open while cells are wiped from the cervix. This sample of cells is sent to a lab to be examined for any abnormalities. It is not a painful test and only takes a few minutes, but it can pick up early changes in the cells of the cervix that may preceed the development of cancer.

Dr. Goldbaum says that women should have pap smears yearly after the age of 21 or within three years of the onset of sexual activity, whichever comes first. The exception, according to the American College of Obstetrics and Gynecology and the American Cancer Society, is for women after the age of 30, especially if they are in low risk relationships and have had three normal annual pap smears. These women can decrease the frequency of their pap smears to every two to three years. Women should still have annual pelvic exams to evaluate the pelvic organs.

If a woman has had a hysterectomy because of cancer or because of abnormal cells in her cervix, then she should continue to have annual pap smears. If she has had a hysterectomy for some other reason, then she does not need regular pap smears because her risks are very low. Dr. Goldbaum emphasizes that each woman should discuss her individual situation and need for screening tests with her doctor.

While women have been having pap smears for many years, testing methods continue to improve and produce more accurate results. Traditionally, the cells from the pap smear have been put onto a slide and sprayed, but now there are some liquid-based tests, where cells are put into a liquid, that seem to have a higher sensitivity in picking up cervical changes.

Most cases of abnormal pap smear results are not indications of cancerous cells. Human papilloma virus (HPV), which is a sexually transmitted virus, is the leading cause of cervical cancer. Evaluation may require further diagnostic procedures, such as a colposcopy. This is a procedure used to determine the nature of abnormal cells found in pap smears. During this procedure, the physician views the cervix through a colposcope, which is a microscope used to look directly at the cervix for patterns of abnormal cells. Sometimes the physician also takes a tissue sample of the abnormal area, which is sent to a lab for evaluation.

When abnormal cells are discovered, treatment is not always necessary. Close follow-up care is often recommended. Sometimes a variety of treatments are used to remove abnormal tissue from the cervix.

If cervical cancer is actually found, the patient is usually referred to a gynecological oncologist for care. Treatment depends on how advanced the cancer is and may include surgery, radiation, or chemotherapy.

Dr. Goldbaum says, “We are very fortunate today that cervical cancer can usually be prevented; however, it is very important for women to receive regular gynecological check-ups in order to maintain their good health.”