Pap smear after 70 up to patient, doctor

Orlando, FL

Question: I am 75. During my last checkup, my gynecologist said I do not need to continue getting Pap smears. This has me concerned as I have done this faithfully all of my adult life. Is it safe to stop?

Answer: This question cannot be answered for you in a column such as this. Only a doctor who does Pap smears and knows you can tell you if it is safe to stop or not. I can, however, try to provide you with some information and context that may help you take this question back to your doctor.

"Pap" stands for Papanicolaou, the name of the doctor who developed this test in the 1940s. Until then, we had no good screening test for cervical cancer, one of the most common cancers among women. The cervix is the opening of the uterus into the vagina.

This is an excellent screening test -- simple and relatively painless, inexpensive, and very sensitive and specific. Countless lives have been saved by this simple test. Medicare pays for Pap smears every other year, but this might not continue.

The Pap smear is done during routine pelvic examinations. A device called a speculum is inserted into the vagina to aid exposure and the surface of the cervix is scraped to obtain cells. These are examined under a microscope for abnormalities.

Pap smears can detect the earliest changes in cervical cells preceding the development of cancer. This offers the possibility of treatment options other than a hysterectomy -- removal of the entire uterus and cervix -- in cases such as when younger women wish to preserve the ability to conceive.

In 2006, new Pap smear guidelines came out. According to these, women at low risk can probably discontinue having Pap smears after 70. Women qualifying as low risk should have had regular Pap smears for years preceding that birthday with no abnormalities. They also should be sexually abstinent or in a mutually monogamous, long-term relationship. One reason for this is the association of cervical cancer and human papilloma virus (HPV), a sexually transmitted infection.

It is important to emphasize that not needing a Pap smear does not mean you can avoid regular pelvic examinations. These are more than just a means of doing a Pap smear. They check for pelvic tumors, ovarian cancer and other pelvic problems. A rectal examination is part of a pelvic and checks for problems in that area.

Women who might not need a Pap smear include those who have had a total hysterectomy, which includes removal of the cervix. Sometimes, however, Pap smears might be advisable even in the absence of the cervix, such as when there might be precancerous changes in the wall of the vagina itself. When a partial hysterectomy is done, the cervix is preserved and taking a Pap smear with the pelvic exam should still be done.

This is not an exhaustive list of who does and who does not need a Pap smear. Ultimately, the decision to discontinue Pap smears should be made between you and the physician who knows you best.

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