The New Pap Smear Guidelines: Are They Right for Black Women and Girls?

The American College of Obstetricians and Gynecologists (ACOG) recently released a revised set of recommendations about Pap smears, which screen for cervical cancer. Doctors now suggest that women get their first screening when they turn 21 instead of within three years of becoming sexually active. They also recommend that the tests be done less frequently--every two years instead of every year.

While most health experts have signed off on the plan, others question whether it's the best idea for Black girls and women, since there is an STD epidemic in the Black community and recent research shows that about 50 percent of Black teenage girls have an active STD. We asked Linda Bradley, M.D., vice chair of ob-gyn at the Cleveland Clinic, the reasons behind the changes and whether there are exceptions that we need to be aware of.

"This is about new scientific information being available," says Dr. Bradley. "Physicians now have more information to guide them in making recommendations about the frequency of a Pap smear--information about the natural history of cervical cancer and [its relationship] to the human papillomavirus (HPV). We're learning, for instance, that some women have a 'double-negative Pap smear,' which means you are so unlikely to develop precancer that doctors can defer tests unless you have been previously diagnosed with HPV."

This is key, Dr. Bradley says, because overtesting could lead to unnecessary procedures that may put a woman's health at risk. "In the past when we've seen patients with HPV, [sometimes] we took out their cervixes. That type of unnecessary treatment of adolescents, for instance, can lead to infertility later--the female may not be able to conceive or could have a premature birth."

Still, Dr. Bradley warns, Pap smear testing every two years beginning at 21 is absolutely crucial--not just to evaluate the health of the cervix but to allow a doctor the opportunity to check for any other possible health issues as well. ACOG states that women and girls who have been vaccinated against HPV follow the same guidelines as those who have not.

"See your health care provider on an annual basis," she continues. This advice also applies to teens and adolescents. "There are other things that doctors do--they check your blood pressure, ask about STDs, [may] test for HIV, give pelvic exams and look for fibroids, test your cholesterol, give nutrition recommendations....African American women are disproportionately at risk for a number of these health issues."

Women 30 years old and up, she adds, need a Pap smear only once every three years if they've had three consecutive normal, negative Pap smears in a row.
Yet the new recommendations don't apply to everyone. "What we're operating with here are just guidelines," she says.

One exception? Young women and girls who begin having sex in their teen or preteen years need to be checked for cervical cancer long before they turn 21. (Your daughter's health provider should recommend when.) "You won't know whether or not you have HPV until you get tested for STDs," says Dr. Bradley. "In order for us to properly assess risk, patients must be honest with their doctors about their sexual histories."

Also, women at higher risk for cervical cancer should get a Pap test every year. This group includes those who are HIV-positive, have had cervical cancer or have been exposed to diethylstilbestrol (DES), a drug once used to suppress lactation as well as to treat advanced breast cancer in postmenopausal women.

In the end, Dr. Bradley says, knowledge is power. Women must familiarize themselves with the new Pap smear guidelines, and if they fall into any of the categories of exceptions described, they should be tested at a younger age or more frequently than once every two years. Women who are not certain that their sexual partners are STD-free (including HIV-negative) or do not use condoms consistently should talk to their doctor about how often they need to be seen—and women who experience symptoms such as bleeding after intercourse, spotting between periods or pelvic pain should call their health care provider immediately.
"And if an older patient comes in with postmenopausal bleeding, you better believe we're going to do a Pap smear on her," she says.

But ultimately, the onus is on the patient to protect herself from STDs and keep up with her own examinations and test results, says Dr. Bradley. "Keep a journal," she says. "Months and years can slip by. Put those dates down in your calendar now so you don't forget."

So while many Black women can follow ACOG's general recommendations, it's probably safest to talk to your doctor about how often you should be tested. And always--always!--use condoms.

Tomika Anderson is a freelance writer whose work has appeared in POZ, Real Health, Uptown and Essence magazines, among others.