By Rachel Fox-Tierney, LM, CPM

With the beginning of the new year and a newly renewed health insurance plan, my health insurance company sent me a glossy infographic from the CDC letting me know what I can do to "Prevent Cervical Cancer with the Right test at the Right time."  Little do they know that I have in-home Pap tests available to me as a "perk" of being a Birthstream midwife, so I will not need to "talk to my doctor today!"  But the letter was a good reminder to answer the question I often am asked by Birthstream families about when they should get a pap test.

What is a Pap test and why do we do them?  Pap smears, also called Pap Tests, are done to check for early changes in cells in your cervix that could indicate a risk for, or the presence of cervical cancer. HPV (human papilloma virus) screening looks for the specific high risk HPV strains that are associated with increased risk of developing cervical cancer. 

"While in general, the risk of cancer is very low for women in the US, representing only 1.5% of all deaths related to cancer in women, it’s not zero." reminds Aviva Romm, MD.

The American Cancer Society estimates that in 2017 in the US there will be an estimated 12,820 new cases of invasive cervical cancer, and 4,210 cervical cancer-related deaths.  Most cases are present in midlife, in women who have not had regular screening or did not follow up with screening guidelines after an abnormal pap.  If you're not sure what your last pap results were, contact your midwife or doctor and have them send you a copy of the results.

Many of us grew up referring to the pap as our "Annual Exam" because women were recommended to have paps every year.  New guidelines no longer recommend yearly paps.  In part because cervical cancer progresses very slowly, and in 93% of the time requires the presence of one of the high risk HPV strains, so HPV status now plays a bigger role in determining frequency of screening.  But also because, more frequent testing has the possibility of over-treatment which can impact pregnancy and birth.

So how often should YOU have a pap?  According to the American Cancer Society's Guidelines from 2012 (and they haven't changed since then):

• Women under the age of 21: NO Paps and NO HPV screening, "HPV is very common in women younger than age 30. Since most HPV that is found in these women will never cause them health problems, it is not useful to test young women for HPV. Most young women will fight off HPV within a few years." according to the CDC.

• Women 21 -29 years old: Paps every 3 years, unless abnormal, and NO HPV screening, unless pap is abnormal.

• Women 30-65 years old: Paps every 3 years, unless abnormal, or Pap test plus HPV screening every 5 years, IF HPV negative . Women who are HPV+ will need more frequent pap screening.

• Women who are over 65 years old: NO paps or HPV screening, IF they have had normal paps for the previous 10 years and no pap with serious pre-cancerous cells for 20 years.

Individual Considerations:

• Women who have had a total hysterectomy (uterus and cervix removed): Stop screening, unless hysterectomy done as a cancer or pre-cancer treatment. You should consult your MD.

• Women who have had a hysterectomy without the removal of the cervix: Screening according to age and risk guidelines above.

• Women who are high risk for cervical cancer because the have a suppressed immune system or were exposed to DES medication in utero: May need to be screened more often.

• Women who have been vaccinated for HPV: Should be screened according to their age and individual risk guidelines. The HPV vaccine does not protect against all strains of HPV.

• Women who are HPV+: Should get pap + HPV screening yearly.

We discuss these guidelines with all of our clients so together we can determine what is the best screening schedule for them given their personal and family history.   We provide pap screening as part of our midwifery care when needed prenatally or postpartum, but we also offer pap screening at any time in a woman's life.

We often get asked,"Can people who aren't Birthstream clients get paps done with you?"  Our answer is, "Of course, because once they use our midwifery service for paps or Well Woman care, then they ARE our clients!  People don't need to have babies with Birthstream in order to enjoy the benefits of in-home Well Woman care!"  

Sometimes medical providers will encourage Pap Screens and describe them as preventative care.  But remember, Pap tests are not really "preventative care", they are "early detection screening tools."  Preventative care is eating a whole food-rich diet, getting walks in the fresh air, having tools for stress management, avoiding smoking and other high risk behaviors, and most of all telling your body what an amazing job it is doing!

There will be some people who do all of the "right things" and still develop cervical cancer because sometimes despite our best efforts we have outcomes that we don't want or expect.  I have cared for people who have developed cervical cancer but have come to the other side, cured in body as well as healed in spirit.  It is possible some times.  So I encourage people to get screened appropriately knowing that I will midwife them through any abnormal results...but likely as is most common, the report will say"within normal limits" or rather as we like to translate "healthy and wonderfully normal cervix!"

If you are interested in having your Pap screen done by a Birthstream midwife, please contact us to schedule an appointment in the comfort and convenience of your own home!

Originally published in February 2017 in Birthstream News