The majority of Australian women have regular Pap smears to prevent cervical cancer. During the Pap smear your doctor will obtain cells from the cervix and those cells can either be normal or abnormal.

In Australia, 2 million women will have a Pap smear every year. Of those, 100,000 are abnormal; however, the majority of these abnormal Pap smears is so mildly abnormal that no treatment is required. Approximately 14,000 women are diagnosed with pre-cancerous changes in the cervix. These precancerous changes are important to detect so that invasive cancer can be avoided. In Australia we have one of the lowest incidence rates of cervical cancer world-wide. Part of the reason is that we have a very well organised Cervical Cancer Prevention program.

Some studies report that Pap smears are unnecessary in older women, while others do show a benefit. The incidence of cervical cancer is greater in adult women under the age of 65 years, however those over 65 years tend to have more fatal cases of the disease.

In Australia, the National Cervical Screening Program currently recommends all women aged between 18 and 69 years who have ever been sexually active have regular Pap tests. In contrast, the US Preventative Services Task Force, American College of Obstetrics and Gynecology and the American Cancer Society suggest that screenings could cease at age 65 years if the woman has not had any cervical abnormalities. In Canada there is no upper age limit.

New findings have been published in the journal Gynecologic Oncology.  Researchers in the US looked at Medicare data from 1991 to 1999 and extracted information from 1,267 women aged 65 years or older who had been recently diagnosed with invasive cervical cancer. The study also used 10,000 patients who had no cancer diagnosis as controls. The researchers determined which of the patients had received a screening Pap smear two to seven years prior to diagnosis.

This study suggests that pap smear screenings reduce the risk of invasive cervical cancer among women in all age groups. Having had a pap smear during the pre-invasive, detectable phase (2 to 7 years prior to cervical cancer diagnosis) was associated with a higher than 40% reduction in the risk of developing cervical cancer overall. Even women over the age of 72 years seemed to benefit from cervical cancer screening.

While the protective effect of Pap smear screening and cervical cancer was strong for squamous tumours (risk reduced by 52%) the same could not be said for adenocarcinoma of the cervix.

Adenocarcinomas arise from the inner lining of the cervical canal and are poorly accessible to the instruments used for taking Pap smears. With one in five cervical cancer patients being diagnosed with an adenocarcinoma, we have to accept that Pap smear screening is not 100% preventative.

Research suggests many patients who we treat for CIN, VIN or VaIN might benefit from HPV vaccination regardless of their age.

Do vaccinated women require Pap smears?

Women today who are aged 65 and over are not included in the immunisation program for the HPV vaccine. Women are also not protected if you have already been infected with HPV types prior to vaccination.

In addition, the HPV vaccine is not 100% effective. It covers some HPV strains but not all.

The renewed National Cervical Screening Program will continue to invite women aged 25 to 74 years, who have or have not had the HPV vaccine, to have cervical cancer screening.

My advice for cervical cancer screening

• Cervical cancer screening is still important for women who have had the HPV vaccine. No vaccine is 100% effective and the vaccine does not protect against all the types of HPV that cause cervical cancer.
• In 2016 we still follow the Pap smear screening that all women should follow every 2 years. The new cervical cancer screening program will be introduced to Australia in 2017, will not smear cells (Pap) but the Human Papilloma Virus (HPV) and will invite women for screening every 5 years.
• Women who had a hysterectomy do not require Pap smears any longer. The only exemption is if the woman had abnormal cervical cells prior to hysterectomy.
• I recommend the HPV vaccine also for women who did receive the HPV vaccination but who suffer from recurrent HPV infections in the cervix, vulva or vagina. These infections could be caused by HPV strains that are not covered by the current vaccine.