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Preventative Care: Pap Smears
Women have a lot on their plates these days so sometimes it can slip our minds to keep up with preventative care, like pap smears. Dr. Molly Thompson walks through what a pap smear entails, what you can expect at your appointment, why it's important to get one, and more.
Featuring:
Outside of work, Dr. Thompson can usually be found outside gardening, playing with her dogs, and staying active.
Molly Thompson, MD
Dr. Molly Thompson is a Family Medicine and Obstetrician physician at the Family Medicine Residency Center, a partnership between Pullman Regional Hospital and Washington State University. Dr. Thompson completed her undergraduate education at Creighton University, medical school at the University of Iowa Carver College of Medicine, and residency at John Peter Smith Family Medicine Residency in Fort Worth, Texas.Outside of work, Dr. Thompson can usually be found outside gardening, playing with her dogs, and staying active.
Transcription:
With a relentless focus on excellence in healthcare, Pullman Regional Hospital presents The Health Podcast.
Deborah Howell (Host): You know, we women have a lot on our plate these days, so it sometimes slips our minds to make appointments for things like preventative care. To tell us a little bit more about preventative care and Pap smears is Dr. Molly Thompson, family medicine physician and Associate Program Director of the WSU Family Medicine Residency Program here at Pullman. Welcome to you, Dr. Thompson.
Dr Molly Thompson: Thank you, Deborah, and thanks for having me. I'm excited to talk about this topic.
Deborah Howell (Host): Excellent. Well, let's dive right in then, because I need to know what is a Papanicolaou test or more commonly known as a Pap smear.
Dr Molly Thompson: Yeah. So, a Pap smear, much easier to say than Papanicolaou, a Pap smear is a procedure where a sterile speculum, meaning a clean speculum is inserted into the vagina to open it so that the cervix can be visualized. And just to make sure everyone's on the same page, the cervix is the very bottom part of the uterus. So once the cervix can be seen, then a little small brush is used to collect a few cells from that cervix. Those cells are then taken under a microscope and looked at to see if they look normal or if they looked abnormal.
For some of these Pap smears, we also test for something called the HPV or human papilloma virus. We do this because the vast majority of cervical cancers, about 95%, are due to changes caused by that virus, which most people will be infected with at some point in their lives.
Deborah Howell (Host): Okay. And besides HPV, what else are you screening for?
Dr Molly Thompson: So, Pap smears are primarily used to screen for pre-cancerous changes or cervical cancer, but it can help us diagnose other things like infections or inflammation as well.
Deborah Howell (Host): And who should be getting a Pap smear and how often should they get one?
Dr Molly Thompson: So in general, people who have a cervix or cervices should be getting Pap smears between the ages of 21 and 65. So, current guidelines are supporting screening people from ages 21 to 29 every three years, that's assuming everything is normal. So if everything is normal, every three years in 21 to 29-year-olds.
Now when a person turns 30, between the age group of 30 and 65, they have the option of three or five years. So if we do a swab that tests not only the cells or the cytology, but also look for that virus, the HPV virus, that could be five years between tests. If you determine or the doctor determines not to use the HPV co-test, then it's every three years, again as long as everything is normal.
Deborah Howell (Host): Okay. And what about women who've had hysterectomies?
Dr Molly Thompson: This depends why a woman's had a hysterectomy. So if they've had a hysterectomy for reasons like pain or bleeding or fibroids, essentially something that is not cancer, then they're done. They don't have a cervix, they do not need screened for cervical cancer. But if they've had a hysterectomy because of pre-cancers or cancers or something like that, then it's a little more nuanced. It could be every year, it could be every three, it could be every five.
Deborah Howell (Host): And what should a patient expect from this type of test? Is there anything they should do to prepare for it?
Dr Molly Thompson: So, a Pap smear's most often done with a speculum, that speculum is inserted into the vagina, which can be slightly uncomfortable. It shouldn't be painful, but uncomfortable. Speculums are usually made of metal or plastic, and they're shaped like a duck's bill. So, sometimes they're cold, sometimes they make clicking sounds. Your doctor should tell you as everything is happening and being performed, so that shouldn't be shocking, but it can be a little uncomfortable.
As far as preparing, there's very little prep needed for a Pap smear. Ideally, avoiding vaginal-based medicines and sexual intercourse one or two days before the Pap smear is preferred for the best kind of sample. The other thing is if a woman is having her full flow menstrual cycle, it may be beneficial to reschedule her Pap. So, spotting or bleeding a little bit is okay. But if there is heavy bleeding, it can obscure the cells that are looked at under the microscope, and then she may be asked to repeat that Pap, which is definitely not ideal.
So ultimately, the best thing a patient can do to prepare for a Pap smear is truly just try and be as relaxed as possible. The more relaxed, the less uncomfortable the speculum is, and thus the Pap smear is. But I know it's easier said than done sometimes.
Deborah Howell (Host): Yeah. But it's only a few minutes, right?
Dr Molly Thompson: Very short.
Deborah Howell (Host): And how long does it take to learn the results?
Dr Molly Thompson: In general, we hear the results back very quickly. Usually less than a week, usually just a couple days.
Deborah Howell (Host): Okay. Okay And as a physician, what do Pap smear results tell you about a patient?
Dr Molly Thompson: So, Pap smears tell us a little bit about a person's risk of developing cervical cancer. Less likely, but possible, we could also learn that a person does have cancer. So, we use these guidelines of how worried we should be about cervical cancer developing. We use this in a way we call grades by saying that there's an abnormality or some cellular changes that are low or high grade changes; high, of course, being the most concerning for progression to cancer.
Deborah Howell (Host): And why is it so important to get a Pap smear every three years?
Dr Molly Thompson: So, we've realized that cervical cancer takes multiple years to develop in women who have normal immune systems. So, it does happen sooner in people who have had weakened immune systems. So ,Pap smears are often safe to be completed every three or five years if they've been normal in the past instead of every single year like we used to think because, again, cervical cancer usually takes multiple years to develop. But it's important to get our Pap smears at regular intervals so that we catch any changes early before their cancer. We want to catch them in the stages before they have become concerning for cancer. So, the sooner the changes are found, the better the outcome.
Deborah Howell (Host): Yeah, that makes perfect sense. And if the results are irregular, what does that mean?
Dr Molly Thompson: So, this question is super nuanced because it depends again on how irregular the Pap is. Some changes we know can just be watched with a repeat Pap smear in a year or so. Other changes are more aggressive and concerning, and we may need to do a procedure like a colposcopy for more information.
A colposcopy is a quick in-office procedure that looks at the cervix under a magnifying tool called a colposcope. Sometimes we would take a small sample of tissue called a biopsy from the cervix to further examine in the lab to determine how worried should we be. But again, not all irregular Pap smears are the same. Some, those low grades, we can just watch for a year and retest. It's the other ones that are more like high grade or persistent that we may have to turn to something like a colposcopy.
Deborah Howell (Host): Okay. And then after the coposcopy, if we have something that we're concerned about, then you make a referral to an oncologist or what happens at that point?
Dr Molly Thompson: Well, again, that kind of depends. So if it is still very concerning, so if you have a colposcopy, a biopsy that shows high-grade changes, meaning there's a high likelihood that this could become cancer, it kind of depends on what the doctor and the patient discuss as far as desired fertility. So if someone wants to continue to be able to carry biologic children in a pregnancy, they may need to do a procedure called a LEEP. A LEEP is essentially taking out the abnormal tissue using a loop that has electrical current through it. That would be kind of an in-office surgical procedure as well. If a woman had high-grade changes and was not looking to have a continued pregnancy, then it would be reasonable to talk to the doctor about other options, such as things like hysterectomies.
Deborah Howell (Host): This is so, so informative. Is there anything else you'd like to add to our conversation?
Dr Molly Thompson: I guess I'd really like to bring up that Pap smears are super important for secondary prevention, meaning catching problems really early so that we can treat them when they're pre-cancerous. But there's actually something we can do for primary prevention as well, meaning the HPV virus, we can stop the HPV V before it infects and causes problems including cancer. The best way to do that for all people of all genders is to get vaccinations against HPV. The best time to do this is prior to the onset of sexual activity, which is why we often start around the age of 9, 10, 11 in adolescence, but it can be used up until the age of 45. I just wanted to make sure I gave a plug for the HPV vaccine because it is an incredible vaccine as it is literally an anti-cancer vaccine.
Deborah Howell (Host): Right. Thanks for that. And Dr. Thompson, we do so appreciate your time. Thanks for all the terrific information and advice you've given us today. We do appreciate you being with us.
Dr Molly Thompson: Thanks so much for having me. This was fun and hopefully informative as well.
Deborah Howell (Host): Very much so. And for more information on this subject, check out www.pullmanregional.org/residencycenter. This has been The Health Podcast from Pullman Regional. I'm your host, Deborah Howell. Thanks for listening and have yourself a terrific day.
With a relentless focus on excellence in healthcare, Pullman Regional Hospital presents The Health Podcast.
Deborah Howell (Host): You know, we women have a lot on our plate these days, so it sometimes slips our minds to make appointments for things like preventative care. To tell us a little bit more about preventative care and Pap smears is Dr. Molly Thompson, family medicine physician and Associate Program Director of the WSU Family Medicine Residency Program here at Pullman. Welcome to you, Dr. Thompson.
Dr Molly Thompson: Thank you, Deborah, and thanks for having me. I'm excited to talk about this topic.
Deborah Howell (Host): Excellent. Well, let's dive right in then, because I need to know what is a Papanicolaou test or more commonly known as a Pap smear.
Dr Molly Thompson: Yeah. So, a Pap smear, much easier to say than Papanicolaou, a Pap smear is a procedure where a sterile speculum, meaning a clean speculum is inserted into the vagina to open it so that the cervix can be visualized. And just to make sure everyone's on the same page, the cervix is the very bottom part of the uterus. So once the cervix can be seen, then a little small brush is used to collect a few cells from that cervix. Those cells are then taken under a microscope and looked at to see if they look normal or if they looked abnormal.
For some of these Pap smears, we also test for something called the HPV or human papilloma virus. We do this because the vast majority of cervical cancers, about 95%, are due to changes caused by that virus, which most people will be infected with at some point in their lives.
Deborah Howell (Host): Okay. And besides HPV, what else are you screening for?
Dr Molly Thompson: So, Pap smears are primarily used to screen for pre-cancerous changes or cervical cancer, but it can help us diagnose other things like infections or inflammation as well.
Deborah Howell (Host): And who should be getting a Pap smear and how often should they get one?
Dr Molly Thompson: So in general, people who have a cervix or cervices should be getting Pap smears between the ages of 21 and 65. So, current guidelines are supporting screening people from ages 21 to 29 every three years, that's assuming everything is normal. So if everything is normal, every three years in 21 to 29-year-olds.
Now when a person turns 30, between the age group of 30 and 65, they have the option of three or five years. So if we do a swab that tests not only the cells or the cytology, but also look for that virus, the HPV virus, that could be five years between tests. If you determine or the doctor determines not to use the HPV co-test, then it's every three years, again as long as everything is normal.
Deborah Howell (Host): Okay. And what about women who've had hysterectomies?
Dr Molly Thompson: This depends why a woman's had a hysterectomy. So if they've had a hysterectomy for reasons like pain or bleeding or fibroids, essentially something that is not cancer, then they're done. They don't have a cervix, they do not need screened for cervical cancer. But if they've had a hysterectomy because of pre-cancers or cancers or something like that, then it's a little more nuanced. It could be every year, it could be every three, it could be every five.
Deborah Howell (Host): And what should a patient expect from this type of test? Is there anything they should do to prepare for it?
Dr Molly Thompson: So, a Pap smear's most often done with a speculum, that speculum is inserted into the vagina, which can be slightly uncomfortable. It shouldn't be painful, but uncomfortable. Speculums are usually made of metal or plastic, and they're shaped like a duck's bill. So, sometimes they're cold, sometimes they make clicking sounds. Your doctor should tell you as everything is happening and being performed, so that shouldn't be shocking, but it can be a little uncomfortable.
As far as preparing, there's very little prep needed for a Pap smear. Ideally, avoiding vaginal-based medicines and sexual intercourse one or two days before the Pap smear is preferred for the best kind of sample. The other thing is if a woman is having her full flow menstrual cycle, it may be beneficial to reschedule her Pap. So, spotting or bleeding a little bit is okay. But if there is heavy bleeding, it can obscure the cells that are looked at under the microscope, and then she may be asked to repeat that Pap, which is definitely not ideal.
So ultimately, the best thing a patient can do to prepare for a Pap smear is truly just try and be as relaxed as possible. The more relaxed, the less uncomfortable the speculum is, and thus the Pap smear is. But I know it's easier said than done sometimes.
Deborah Howell (Host): Yeah. But it's only a few minutes, right?
Dr Molly Thompson: Very short.
Deborah Howell (Host): And how long does it take to learn the results?
Dr Molly Thompson: In general, we hear the results back very quickly. Usually less than a week, usually just a couple days.
Deborah Howell (Host): Okay. Okay And as a physician, what do Pap smear results tell you about a patient?
Dr Molly Thompson: So, Pap smears tell us a little bit about a person's risk of developing cervical cancer. Less likely, but possible, we could also learn that a person does have cancer. So, we use these guidelines of how worried we should be about cervical cancer developing. We use this in a way we call grades by saying that there's an abnormality or some cellular changes that are low or high grade changes; high, of course, being the most concerning for progression to cancer.
Deborah Howell (Host): And why is it so important to get a Pap smear every three years?
Dr Molly Thompson: So, we've realized that cervical cancer takes multiple years to develop in women who have normal immune systems. So, it does happen sooner in people who have had weakened immune systems. So ,Pap smears are often safe to be completed every three or five years if they've been normal in the past instead of every single year like we used to think because, again, cervical cancer usually takes multiple years to develop. But it's important to get our Pap smears at regular intervals so that we catch any changes early before their cancer. We want to catch them in the stages before they have become concerning for cancer. So, the sooner the changes are found, the better the outcome.
Deborah Howell (Host): Yeah, that makes perfect sense. And if the results are irregular, what does that mean?
Dr Molly Thompson: So, this question is super nuanced because it depends again on how irregular the Pap is. Some changes we know can just be watched with a repeat Pap smear in a year or so. Other changes are more aggressive and concerning, and we may need to do a procedure like a colposcopy for more information.
A colposcopy is a quick in-office procedure that looks at the cervix under a magnifying tool called a colposcope. Sometimes we would take a small sample of tissue called a biopsy from the cervix to further examine in the lab to determine how worried should we be. But again, not all irregular Pap smears are the same. Some, those low grades, we can just watch for a year and retest. It's the other ones that are more like high grade or persistent that we may have to turn to something like a colposcopy.
Deborah Howell (Host): Okay. And then after the coposcopy, if we have something that we're concerned about, then you make a referral to an oncologist or what happens at that point?
Dr Molly Thompson: Well, again, that kind of depends. So if it is still very concerning, so if you have a colposcopy, a biopsy that shows high-grade changes, meaning there's a high likelihood that this could become cancer, it kind of depends on what the doctor and the patient discuss as far as desired fertility. So if someone wants to continue to be able to carry biologic children in a pregnancy, they may need to do a procedure called a LEEP. A LEEP is essentially taking out the abnormal tissue using a loop that has electrical current through it. That would be kind of an in-office surgical procedure as well. If a woman had high-grade changes and was not looking to have a continued pregnancy, then it would be reasonable to talk to the doctor about other options, such as things like hysterectomies.
Deborah Howell (Host): This is so, so informative. Is there anything else you'd like to add to our conversation?
Dr Molly Thompson: I guess I'd really like to bring up that Pap smears are super important for secondary prevention, meaning catching problems really early so that we can treat them when they're pre-cancerous. But there's actually something we can do for primary prevention as well, meaning the HPV virus, we can stop the HPV V before it infects and causes problems including cancer. The best way to do that for all people of all genders is to get vaccinations against HPV. The best time to do this is prior to the onset of sexual activity, which is why we often start around the age of 9, 10, 11 in adolescence, but it can be used up until the age of 45. I just wanted to make sure I gave a plug for the HPV vaccine because it is an incredible vaccine as it is literally an anti-cancer vaccine.
Deborah Howell (Host): Right. Thanks for that. And Dr. Thompson, we do so appreciate your time. Thanks for all the terrific information and advice you've given us today. We do appreciate you being with us.
Dr Molly Thompson: Thanks so much for having me. This was fun and hopefully informative as well.
Deborah Howell (Host): Very much so. And for more information on this subject, check out www.pullmanregional.org/residencycenter. This has been The Health Podcast from Pullman Regional. I'm your host, Deborah Howell. Thanks for listening and have yourself a terrific day.