Dear Dr N I am confused about paps. Can you explain? L.M.

Dear L. A pap is an exam to screen for cervical cancer. Most cervical cancers are preventable with paps except the rare paps of the glandular cells of the cervix can be found at late stages. The test is a sampling of the cells of the cervix after the provider ‘sees’ it. That is one of the keys of a good pap, visualize and then sample. Some are harder to find than others but if I can’t see it I can’t adequately sample it. We are not doing paps on women under 21 AND we are doing an additional test on paps now in women over 30 to enhance the sensitivity. We are sending an HPV DNA probe with the pap because without HPV DNA the liklihood of cervical cancer is again, very low. So because of the sensitivity of paps recently, the recommendation is now that the screening does not have to be done yearly. Exams are useful for other reasons but the pap itself is not necessary. Depending on your provider- they may recommend every 2 or 3 years. The recommendation of 3 years is so hard to remember for women – I favor every other year to help compliance. This is something we talk about at your exam. Depending on risk factors we can also stop doing paps around age 75 but that does not mean no exam. I found a cancer of the vulva in a 95 year old! Someone still needs to look even if we are not doing paps. In countries where there are not labs or the ability to do a pap, an exam and something called a vinegar test is done to see if abnormal cells are present and a biopsy can be done. This is certainly better than nothing but a conventional pap is better and an excellelnt screening test. It finds problems in time to treat it. I hope that helps your confusion. Dr N