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    Many Women May Not Need a Pap Test Every Year


    When women see their gynecologists for their annual exams, he says, they should discuss the possibility of going more than a year between Pap tests. "I think we should not get into ruts," he says. "It is really time for us to sit back and consider what it means to provide well-woman care. It might not be annual screening for cervical cancer. It might be screening for depression, or domestic violence, or seat belt use."

    He notes that insurance companies may want to direct resources away from annual Paps for women at low risk of cervical cancer, and instead spend more money on reminder cards and other ways to convince women who haven't regularly had Pap smears to get them.

    Although Sawaya adds that the annual gynecological exam itself should not be skipped, D. Paul Shackelford, MD, worries that women may miss their annual physicals if they think a Pap is no longer required.

    Such a visit is still valuable, Shackleford argues, because the woman should also undergo tests for colon cancer as well as a breast exam and evaluations of her height, weight, and blood pressure. He also orders mammograms, cholesterol tests, and immunizations for patients who need them. He says he often has to convince women who have had hysterectomies that the annual visit is important. Shackelford is an assistant professor and chief of the division of gynecology in the department of obstetrics and gynecology at East Carolina University, in Greenville, N.C.

    "I think if a woman is low risk [for cancer] and has had three normal Paps in three years, then it is appropriate to skip one year," Shackleford says. "But I have never advocated skipping it unless the patient mentions it."

    For now, Shackelford will continue to follow the recommendations for annual Paps. "It's pretty hard to go against convention," he says.

    But, he adds, "anything we can do to improve the effectiveness of our screening services would be valuable."

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