Pap Smear: When Less is Best

Less is best? Less pap smears, less breast exams, etc.

When was your last annual check up with your gynecologist?

A lot of things have changed since you last saw your doctor.

1. Self Breast Examination (SBE) not effective in decreasing number of deaths from breast cancer.

Physicians used to advise women to do a monthly breast exam after their menstruation to detect any masses or lesions. Several internationally-recognized governing bodies including the American Cancer Society have downplayed the relevance of the self-breast examination (SBE).

Women who performed SBE tend to have a false sense of security that they are cancer-free just because they vigilantly do SBE every single month.

Research has shown that a mass detected by the examining hand is too big and too far advanced to be of help in saving a patient’s life, or her breast, for that matter.

Mammogram is the only method recommended in early detection of breast cancer.

This recommendation is not informing women to stop performing SBE’s. What this signifies is despite a normal SBE one should still do a yearly mammogram.


2. Yearly pap smears not necessary.

A pap smear is primarily performed to detect cervical cancer. It is not to check for sexually transmitted infection (STI).

Each STI, for instance, syphilis, chlamydia or gonorrhea has a specific diagnostic test to check for the presence of these organisms.

Sometimes a pap smear will incidentally see trichomonas infection, which is sexually transmitted, but this is purely by chance.

With the advent of the cervical cancer vaccines, more and more women are now protected from this type of cancer.

Scientists also note that cervical cancer is a slow growing tumor. Data reveals no additional benefit on a woman if she undergoes this procedure on a yearly basis.

Both the National Cancer Institute and American College of Obstetricians and Gynecologists now advise screening every 3 years for asymptomatic women.

Take note that the kind of pap smear discussed here is the “liquid-prep” or the pap smear using the cyto-brush.

Women undergoing a pap smear using the cotton applicator method still need a yearly examination.


3. Internal vaginal examination has no scientific basis.

The most recent of these game-changing recommendations is the pelvic examination, also called an internal vaginal examination or bimanual examination.

Doing an internal examination is a permanent component of any woman’s yearly check-up.

Recently published in the December 13, 2011 issue of the Archives of Internal Medicine, the authors Stormo, Hawkins, Cooper and Saraiya concluded that many pelvic examinations are merely performed “out of habit” or part of a routine.

There is no scientific evidence to support the performance of bimanual examination on an asymptomatic women for the purpose of checking for sexually transmitted infection, ovarian and other gynecologic cancer and to determine if it is safe for her to take hormonal contraceptives.

There is still no clear recommendation from international regulating bodies whether the pelvic examination should be omitted in the list of tests to perform in the annual check up of women.

Till the final word is out, physicians must still perform a pelvic examination on all patients in order to be thorough.

It would be a terrible mistake to miss out on anything especially for a patient who values her health enough to visit a doctor every year even without having symptoms. It is even advised that it is best not to wait for symptoms.

Very often,  when there are symptoms it is already too late.

Doc D Signature
TAGS: , , , , , , , , , , ,


  1. Dainz says:

    Doc, why is it that patients undergoing the cotton applicator pap smear still need yearly checkup? What is its difference from the liquid prep?

    • filipinamd says:

      Liquid prep is more accurate but more expensive. If you use this method pwedeng every 3 years na lang ang pap smear mo.
      Cotton applicator is cheaper but can miss out some early cancer cells, so yearly pa rin ang pap smear, especially if you have no cervical vaccine yet.
      In some journals and some international societies, if you have completed 3 injections of the cervical vaccine, you need only a pap smear every 3 years.