The United States Preventive Task Force and the American Cancer Society released new guidelines for cervical cancer screenings – PAP and HPV for women ages 21- 65.
Summit Medical Group family medicine physician, Dr. Rashmi Srinivas, discusses the new guidelines and resources for keeping up-to-date on these preventive health measures.
Selected Podcast
Pap Smear Guidelines: What You Should Know
Featured Speaker:
Rashmi Srinivas, MD
Rashmi Srinivas, MD, specializes in family medicine.Dr. Srinivas is a member of the American Academy of Family Physicians. She is the recipient of the Robert Wood Johnson Medical School Family Medicine Academic Excellence Award and Richard Rapkin Society in Pediatric Medicine Outstanding Leadership Award.Dr. Srinivas participates in various volunteer projects. She has been a project coordinator for Healthy Families for Life, a community outreach initiative to help fight childhood obesity. In addition to volunteering for the American Academy of Family Physicians tobacco-free program, she designed the Literacy Initiative for lifestyle and literacy for Spanish-speaking seniors in New Brunswick. Her volunteer experiences have taught her the important role a community has in caring for patients. It also inspired her to pursue a career in primary care. Dr. Srinivas says, "I wanted a career in medicine because it allows me to transform people's lives. I am devoted to providing personalized, compassionate care for each of my patients."When she is not working with her patients, Dr. Srinivas enjoys classical dance of South India. She has performed and competed in cultural events and state-wide competitions. She also enjoys reading and traveling. Transcription:
Pap Smear Guidelines: What You Should Know
Melanie Cole (Host): The United States Preventive Task Force and the American Cancer Society released new guidelines for cervical cancer screenings, Pap and HPV for women 21 through 65. Today, my guest is Summit Medical Group family medicine physician, Dr. Rashmi Srinivas, here to discuss those new guidelines. Welcome to the show, Dr. Srinivas. Tell us a little bit about the new Pap smear guidelines and what every woman should know. When should we start getting our Pap smears?
Dr. Rashmi Srinivas (Guest): Thank you for, again, having me on this show. The guidelines have changed. The new Pap smear guidelines since 2012 have been that women should start getting health screening at the age of 21. Before, it was thought to be prior to 21 if you were sexually active, three years prior. Right now, this is universal to everybody. At the age of 21, you should start getting your Pap smears and it should be at various intervals depending on your age group. Between the ages of 21 to 29, it should be every three years and that is Pap smear only. Once you turn 30 to 65, you want to get both HPV, which is the human papillomavirus testing, along with the Pap smear because human papillomavirus does change to – cause cervical cancer that’s why they should be co-tested. There’s more risk for women who are above 30 as they are less likely to clear that infection. If you do get both testing or what is called co-testing, it could be extended to every five years. But if you just get a Pap smear, it could be every three years. ypically the age that you stop is around the age of 65. That’s a loose guideline because really it depends on whether the woman adequately was cleaned prior to this, which means they have been getting regular Pap smears up till now and whether they had a hysterectomy, which means the uterus was removed. Typically, you can stop if it’s because of a benign lesion, if it’s not cancer, you can stop screening when that’s done; but if it’s not, we do recommend that you continue getting screened with a Pap smear.
Melanie: What’s involved in a Pap smear? Now, you and I both know if we’ve had them, but for anyone listening that has never had one or is afraid of getting them, it’s really not that big a deal and it takes just a matter of minutes, mere minutes. Explain the procedure just a little bit and then what happens after you get your Pap smear. It goes on to pathology or to the lab. Give us a little bit of the procedure here.
Dr. Srinivas: Sure. Pap smear really could be done right at the doctor’s office. It doesn’t have to be done in an operating room or anything like that. Done right at the doctor’s office, it takes about two to five minutes at most. It’s usually typically done when the woman comes in for her annual gynecological exam or annual physical exam. Basically entails women lying on her back, sitting with her legs wide open onto the sides, and the doctor typically will view her cervix by using a tool called a speculum. That allows the doctor to visualize the vagina as well as the cervix to allow for sampling of the cells outside of the cervix as well as inside of the cervix. That’s what a Pap smear entails, basic sampling of cells outside of the cervix as well as inside. Through that same test, the doctor can also test for human papillomavirus as well as gonorrhea and chlamydia. After this, it’s sent off to the lab to be processed. It usually takes about, I would say, 48 to 72 hours for the results to come back.
Melanie: Tell us about those results, because an abnormal result, a positive result on your Pap smear doesn’t necessarily mean you have cervical cancer, although that’s the first thing that’s going to go through every woman’s mind. Speak about the results a little bit.
Dr. Srinivas: Sure. So once the doctor calls the patient with the results, it’s typically – there’ll be pathology lingo that I don’t want to get into it, but basically, it could be satisfactory for evaluation and completely benign and that means that the woman doesn’t have to worry. She can go through usual testing, as we discussed, the usual intervals of testing. However, if the doctor comes back and says, “Okay, the results are abnormal. Pap smear is abnormal,” it could mean one of various things. It could mean that there are some abnormal cells that we don’t know what it is and it doesn’t necessarily mean cervical cancer. It just means there are some cells that are abnormal that need further evaluation. Sometimes, the doctor will call the patient back saying, “You know what, I need you to come back in for another visit, we need to do a little bit more complex Pap smear,” a little bit longer Pap smear that’s done through a microscope and the technical name for that is a colposcopy. Sometimes, that more complicated Pap smear, a longer Pap smear, needs to be done to really look closely at the cells of the cervix because there are some abnormal cells that need to be identified. However, sometimes, as you said, that could be the result of cancer. Now, there are different stages of the cervical cancer: stage I, stage II, stage III, etcetera. Really depends on how abnormal the cells are to be able to discern what stage it falls under. Then, at that time, the family doctor may refer the patient to an OB-GYN to further manage that patient. Sometimes also, as we talked about co-testing, the human papillomavirus may be positive. In that case, there are certain recommendations where the patient may need to come back in maybe six months to a year to get a re-test done, because sometimes the infection can be cleared on their own. Nothing needs to be done. No treatment needs to be administered, but just mainly monitoring. Those are the possibilities of results from a Pap smear.
Melanie: If we test negative for the HPV virus, for human papillomavirus, is this something that – I mean I get a Pap smear every year, Dr. Srinivas. Is this something that needs to be checked every three to five years or something, or once you test negative for it 20 years later, you don’t need to be checked for HPV and that co-testing situation anymore?
Dr. Srinivas: No. If you are negative for HPV and the Pap smear is completely normal, you go back to the regular screening guidelines that I discussed at the beginning of this talk. Those who are between the ages of 30 to 65, go back to testing every five years, regardless if you are negative. Same thing if you are younger, between the ages of 21 to 29, you go back every three years. Now, if there are certain risk factors, let’s say you have a new sexual partner, because the human papillomavirus can be transmitted sexually, that’s why I’m talking about this, that is, these are risk factors. Let’s say that you have a new sexual partner where you’re practicing high-risk sexual activity without using any protection, your partner. You may need to be tested more frequently. It’s really up to the discretion of the physician, the primary care doctor, and certainly the results of the last Pap smear. It can certainly change the screening recommendations at that point. Certainly if you’re a smoker, it puts you at high risk. You tend not to clear an infection as commonly and you are at more risk for cervical cancer. There are certain risk factors for this that can change the guideline, but typically if you are 21 to 29, it’s every three years; between age 30 to 65, every three to five years.
Melanie: In just the last couple of minutes, please tell the listeners why they should come to Summit Medical Group for their continuing care and your best advice on Pap smear guidelines and what we should be doing to keep ourselves safe and prevent cervical cancer.
Dr. Srinivas: When you say that, it’s good to be part of Summit Medical Group because there is great communication throughout our group. There is a wonderful internal referral system so if you need further care or further evaluation, we can send you to our doctors here, and there is direct communication. We use the same electronic medical records so the other providers can look at our medical records, so there is really great transparency to medical care in this group. We really focus on access and convenience for the patients and quality care in this group. To conclude for Pap smear and cervical cancer screening, I just want to let all women know that go get your Pap smear, go get your screening done. It’s really important and it only takes about two to five minutes to get the results done. It really goes to advocacy for your own health and prevention of what we call cervical cancer. Certainly, we didn’t talk too much about human papillomavirus, the vaccine, but that’s also something that is available and out there for young teenagers and I highly encourage them to go get their vaccines. In that way, they could prevent this infection and possibly prevent the onset of cervical cancer. Thank you.
Melanie: Really great and very important information. Thank you so much. You’re listening to SMG Radio and for more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.
Pap Smear Guidelines: What You Should Know
Melanie Cole (Host): The United States Preventive Task Force and the American Cancer Society released new guidelines for cervical cancer screenings, Pap and HPV for women 21 through 65. Today, my guest is Summit Medical Group family medicine physician, Dr. Rashmi Srinivas, here to discuss those new guidelines. Welcome to the show, Dr. Srinivas. Tell us a little bit about the new Pap smear guidelines and what every woman should know. When should we start getting our Pap smears?
Dr. Rashmi Srinivas (Guest): Thank you for, again, having me on this show. The guidelines have changed. The new Pap smear guidelines since 2012 have been that women should start getting health screening at the age of 21. Before, it was thought to be prior to 21 if you were sexually active, three years prior. Right now, this is universal to everybody. At the age of 21, you should start getting your Pap smears and it should be at various intervals depending on your age group. Between the ages of 21 to 29, it should be every three years and that is Pap smear only. Once you turn 30 to 65, you want to get both HPV, which is the human papillomavirus testing, along with the Pap smear because human papillomavirus does change to – cause cervical cancer that’s why they should be co-tested. There’s more risk for women who are above 30 as they are less likely to clear that infection. If you do get both testing or what is called co-testing, it could be extended to every five years. But if you just get a Pap smear, it could be every three years. ypically the age that you stop is around the age of 65. That’s a loose guideline because really it depends on whether the woman adequately was cleaned prior to this, which means they have been getting regular Pap smears up till now and whether they had a hysterectomy, which means the uterus was removed. Typically, you can stop if it’s because of a benign lesion, if it’s not cancer, you can stop screening when that’s done; but if it’s not, we do recommend that you continue getting screened with a Pap smear.
Melanie: What’s involved in a Pap smear? Now, you and I both know if we’ve had them, but for anyone listening that has never had one or is afraid of getting them, it’s really not that big a deal and it takes just a matter of minutes, mere minutes. Explain the procedure just a little bit and then what happens after you get your Pap smear. It goes on to pathology or to the lab. Give us a little bit of the procedure here.
Dr. Srinivas: Sure. Pap smear really could be done right at the doctor’s office. It doesn’t have to be done in an operating room or anything like that. Done right at the doctor’s office, it takes about two to five minutes at most. It’s usually typically done when the woman comes in for her annual gynecological exam or annual physical exam. Basically entails women lying on her back, sitting with her legs wide open onto the sides, and the doctor typically will view her cervix by using a tool called a speculum. That allows the doctor to visualize the vagina as well as the cervix to allow for sampling of the cells outside of the cervix as well as inside of the cervix. That’s what a Pap smear entails, basic sampling of cells outside of the cervix as well as inside. Through that same test, the doctor can also test for human papillomavirus as well as gonorrhea and chlamydia. After this, it’s sent off to the lab to be processed. It usually takes about, I would say, 48 to 72 hours for the results to come back.
Melanie: Tell us about those results, because an abnormal result, a positive result on your Pap smear doesn’t necessarily mean you have cervical cancer, although that’s the first thing that’s going to go through every woman’s mind. Speak about the results a little bit.
Dr. Srinivas: Sure. So once the doctor calls the patient with the results, it’s typically – there’ll be pathology lingo that I don’t want to get into it, but basically, it could be satisfactory for evaluation and completely benign and that means that the woman doesn’t have to worry. She can go through usual testing, as we discussed, the usual intervals of testing. However, if the doctor comes back and says, “Okay, the results are abnormal. Pap smear is abnormal,” it could mean one of various things. It could mean that there are some abnormal cells that we don’t know what it is and it doesn’t necessarily mean cervical cancer. It just means there are some cells that are abnormal that need further evaluation. Sometimes, the doctor will call the patient back saying, “You know what, I need you to come back in for another visit, we need to do a little bit more complex Pap smear,” a little bit longer Pap smear that’s done through a microscope and the technical name for that is a colposcopy. Sometimes, that more complicated Pap smear, a longer Pap smear, needs to be done to really look closely at the cells of the cervix because there are some abnormal cells that need to be identified. However, sometimes, as you said, that could be the result of cancer. Now, there are different stages of the cervical cancer: stage I, stage II, stage III, etcetera. Really depends on how abnormal the cells are to be able to discern what stage it falls under. Then, at that time, the family doctor may refer the patient to an OB-GYN to further manage that patient. Sometimes also, as we talked about co-testing, the human papillomavirus may be positive. In that case, there are certain recommendations where the patient may need to come back in maybe six months to a year to get a re-test done, because sometimes the infection can be cleared on their own. Nothing needs to be done. No treatment needs to be administered, but just mainly monitoring. Those are the possibilities of results from a Pap smear.
Melanie: If we test negative for the HPV virus, for human papillomavirus, is this something that – I mean I get a Pap smear every year, Dr. Srinivas. Is this something that needs to be checked every three to five years or something, or once you test negative for it 20 years later, you don’t need to be checked for HPV and that co-testing situation anymore?
Dr. Srinivas: No. If you are negative for HPV and the Pap smear is completely normal, you go back to the regular screening guidelines that I discussed at the beginning of this talk. Those who are between the ages of 30 to 65, go back to testing every five years, regardless if you are negative. Same thing if you are younger, between the ages of 21 to 29, you go back every three years. Now, if there are certain risk factors, let’s say you have a new sexual partner, because the human papillomavirus can be transmitted sexually, that’s why I’m talking about this, that is, these are risk factors. Let’s say that you have a new sexual partner where you’re practicing high-risk sexual activity without using any protection, your partner. You may need to be tested more frequently. It’s really up to the discretion of the physician, the primary care doctor, and certainly the results of the last Pap smear. It can certainly change the screening recommendations at that point. Certainly if you’re a smoker, it puts you at high risk. You tend not to clear an infection as commonly and you are at more risk for cervical cancer. There are certain risk factors for this that can change the guideline, but typically if you are 21 to 29, it’s every three years; between age 30 to 65, every three to five years.
Melanie: In just the last couple of minutes, please tell the listeners why they should come to Summit Medical Group for their continuing care and your best advice on Pap smear guidelines and what we should be doing to keep ourselves safe and prevent cervical cancer.
Dr. Srinivas: When you say that, it’s good to be part of Summit Medical Group because there is great communication throughout our group. There is a wonderful internal referral system so if you need further care or further evaluation, we can send you to our doctors here, and there is direct communication. We use the same electronic medical records so the other providers can look at our medical records, so there is really great transparency to medical care in this group. We really focus on access and convenience for the patients and quality care in this group. To conclude for Pap smear and cervical cancer screening, I just want to let all women know that go get your Pap smear, go get your screening done. It’s really important and it only takes about two to five minutes to get the results done. It really goes to advocacy for your own health and prevention of what we call cervical cancer. Certainly, we didn’t talk too much about human papillomavirus, the vaccine, but that’s also something that is available and out there for young teenagers and I highly encourage them to go get their vaccines. In that way, they could prevent this infection and possibly prevent the onset of cervical cancer. Thank you.
Melanie: Really great and very important information. Thank you so much. You’re listening to SMG Radio and for more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.