While caring for a 17-year-old surgical patient, I got to know her and her mother quite well. One day her mother asked me when her daughter should have her first Pap test. What's the current recommendation for teenagers?—B.E., MD.
Mavis Schorn, RN, CNM, MS, replies: The recommendations for the Pap test for cervical cancer have changed for women of all ages in recent years: The American Cancer Society (ACS) revised its guidelines in 2002, and the American College of Obstetricians and Gynecologists (ACOG) followed suit in 2003. Both organizations recommend that screening for cervical cancer begin about 3 years after a woman begins having vaginal intercourse, but no later than age 21. In young sexually active women, human papillomavirus (HPV) may cause precancerous changes that can lead to cervical cancer. A woman who hasn't had sexual intercourse isn't likely to have acquired HPV, so it's also unlikely that she'd have cervical cancer.
A woman should continue having Pap tests every year until age 30, according to the ACOG. The ACS gives the same recommendations, but says women over age 30 can reduce testing frequency to every 2 to 3 years if their health care provider uses the newer liquid-based Pap tests, which include HPV typing.
Remember that some women mistakenly believe that the terms Pap test and pelvic exam are the same, so clarify the terms for your patient and her mother if necessary. According to the ACOG, all women 18 or older should have annual gynecologic exams, including a pelvic exam, whether or not they're sexually active. Regardless of age, girls who are sexually active or contemplating sexual activity should have annual pelvic exams with testing for sexually transmitted diseases and contraceptive and safer-sex counseling. A teen who's having menstrual problems or who hasn't menstruated by age 16 also may need a pelvic exam.
Mavis Schorn is a certified nurse-midwife in the Nurse-Midwifery Faculty Practice at Vanderbilt University Medical Center in Nashville, Tenn., and an assistant professor in the nurse-midwifery education program at Vanderbilt University School of Nursing. Clinical Queries is coordinated by Joan E. King, RN, C, ACNP, ANP, PhD, program director for the acute care nurse practitioner program at Vanderbilt University.
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Saslow, D., et al.: “American Cancer Society Guideline for the Early Detection of Cervical Neoplasia and Cancer,” CA: A Cancer Journal for Clinicians
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