Do I really need to do this?

 In Prevention

Over the past several years, traditional guidelines for screening tests, such as Pap smears and Mammography, have been challenged.  To review, Pap Smears are a screening test for the cervix which can detect abnormalities before they become cancer.  Mammograms are the single most effective test to screen for breast cancer, often catching the disease at a stage which is still curable.

With regard to either test, I could spend a lot of time writing about the benefits and potential pitfalls.  But I’m not going to do that here.  Information has been presented, and recommendations have been given.  It is up to the news media (and well-meaning family members) to confuse you.  My job is to clarify.  So, I’m going to cut through all the hype and let you know what happened, and what the current recommendations are.  Sound good?  Here we go.

Pap Smears

Until relatively recently, yearly Pap smears were recommended for all women 21 or over and sexually active women under 21 (starting 3 years after first sexual experience).  Here’s a brief summary of current recommendations, by age group:

  • Under 21 years old
    • There is no reason to perform a Pap smear in this age group
  • 21 to 30 years old
    • Pap smears every 3 years
  • 30 years and older
    • Pap smears every 5 years, as long as she:
      • has had 3 consecutive normal Pap smears
      • has never had dysplasia (or “pre-cancer”)
      • does not have HIV or another reason for a weakened immune system
  • After age 65, or for women with a hysterectomy (for benign conditions)

    • There is no reason to perform a Pap smear in this age group


In November of 2009, the USPSTF (mentioned above) put forth recommendations for mammograms which stated that women ages 50-74 have mammograms every 2 years.  If you are under 50, or over 74, the choice is essentially yours.  They also recommended against breast exams (yes, you read that correctly).  This set off what has been described as a “Media Firestorm”.  Most of us remember it, I won’t recount it here in detail.  Suffice it to say that most physicians, and in fact most women, loudly disagreed.

So, what has changed?  Simple answer: nothing.  The recommendations of the American Cancer Society, which most physicians I know continue to follow, still stand:

  • Yearly mammograms are recommended starting at age 40
  • Clinical breast exams (by a healthcare provider) are recommended every 3 years starting between ages 20-30 (some of us do them every year at this stage), and every year after 40

While this holds true for most women, screening recommendations may vary based on family and personal history – but will most definitely not be less frequently recommended.

Some Points to Remember

Point 1:  A Pap Smear is NOT the same as a yearly examination.  Yearly exams are still recommended for all adult women, every year (with few, if any, exceptions).  So, if it has been a year since I’ve last seen you, don’t forget to make your appointment!

Point 2:  Substitutes for mammography, for the purpose of breast cancer screening, have been suggested (thermography, for example).  Mammography is currently the only FDA-approved screening test for breast cancer.  (MRI is a special case, well beyond the scope of this post.)  If you’re over 40 (including those who are celebrating the 1st anniversary of their 39th birthday…), get your mammogram!

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