Dr. Kim Foster: Wicked Health


New Pap Screening Guidelines

Wait...I don't need a pap every year anymore?

Used to be, getting a pap was your yearly routine. But things have changed. Have you tried to book an appointment lately? You may have noticed some policy changes at your doctor’s office. And these changes are causing a fair bit of confusion.

On our YMC Facebook page recently, a member asked: Why do women now have to wait 3 years to get a pap done? Why is this service no longer available during an annual physical?

Are you wondering the same thing? Well, here’s the deal.

First of all, nobody is disputing the importance of pap smears. Paps can diagnose cervical cancer—and its precursors—at a very early stage, with plenty of time to treat and cure the disease. There is no doubt Paps save lives. But...in this case, there is such a thing as too much of a good thing.

After much international research, it seems that starting paps at a young age, and repeating them frequently, is unnecessary. And the danger of overdoing it with a screening technique means that you’re going to unearth many more borderline abnormal results than you otherwise would. Which means a lot of women have unnecessarily been subjected to colposcopy and interventions like cryotherapy and cervical biopsies that carry the potential for harms like bleeding, pain, and discharge. Worse, they may increase the risk of early loss of future pregnancies or premature labour. Not to mention all the anxiety caused by those false alarms.

Thing is, we’ve probably been overdoing this pap thing for a while now. Many other countries around the world (European countries, in particular) have been doing less frequent testing for quite some time and have achieved the same reductions in cervical cancer rates as we have in Canada.

The recent reduction in pap frequency in Canada is consistent with current research findings, and it’s also in line with what most developed countries are doing. For example:  

  • The UK has a recommended policy of not starting paps until over the age of 25, and only every 3 years.
  • The US recommendations? Every 3 years, over the age of 21.
  • Australia currently recommends doing screening paps every 2 years, but this is possibly set to change.

Screening guidelines in Canada are determined at the provincial level, but all of the provinces are heading in the same direction. Here’s a sampling:


Cancer Care Ontario now recommends (as of Aug 2012) that cervical cancer screening start at age 21 and continue every three years until age 70 for all women who are, or ever have been, sexually active.


Pap screening is advised to start at age 21, if sexually active, and continue every three years until age 70.

British Columbia

Women should start having pap tests at age 21 or 3 years after first sexual contact. Pap tests should be done every year for the first 3 years; then continue every 2 years if results are normal.

As I was looking at Alberta’s guidelines, I came across an info sheet for patients produced by Alberta Health Services that I thought offered a pretty clear explanation. So here it is, excerpted directly:

  • Most cervical cell changes are caused by infections with certain types of the human papillomavirus (HPV).
  • These types of HPV are spread by sexual contact.
  • HPV is common and spreads so easily that over 70% of people will get HPV in their lifetime.
  • Most people don’t even know when they have HPV because there are usually no symptoms.
  • The immune system will usually clear the HPV within 2 years.
  • When the virus does not clear, it can cause cell changes that may lead to cervical cancer. These changes happen slowly.
  • By getting Pap tests at least once every 3 years, cervical cell changes can be found early and if needed, treated so that cancer does not develop

As with many things, as we research more and understand more, and start to take into consideration the nuances of what we’re doing...we modify our approaches, and revise our recommendations.

If there’s one thing I’ve learned, you can be sure this will not be the last word on this subject. Things will change with these recommendations, as with everything that has to do with the incredibly complex human body and our even more complex disease processes.

It’s a sticky issue, however, because these guidelines are based on population-based research. Which means they’re looking at what’s best for the population, as a whole. There will always be individual cases that fall outside these averages. But how can you make guidelines for an entire population if you take into account every individual possibility? No easy answers there.

So, tell me: do you get regular paps done? What do you think of the new guidelines?