PAP SMEARS (Cervical Cancer Screening) – How Often?

We used to think of the dreaded PAP smear as part of our annual duty of care to ourselves…but it looks like you may get a bit of reprieve with the new, almost globally recognized, protocols for PAP smear screening.


Why should I have a PAP smear?

Cancer of the cervix (kanker leher rahim) is the second most common cause of cancer-related disease and death among women worldwide. The best way to prevent cervical cancer is by having regular Papanicolaou (Pap) tests. A Pap test can detect viral infections (such as human papillomavirus) and other cancer-causing conditions. Early treatment of these conditions can stop cervical cancer before it fully develops. A woman can have cervical cancer and not know it because she may not have any symptoms.

The occurrence of cervical cancer has decreased because of Pap test screening. Many women (millions) are found to have abnormal Pap tests each year. Most of them are early stage and need reasonable observation by doctor.

  • Risks factors for cancer of the cervix

–  Multiple sexual partners (or sexual partners who have had multiple partners)

–  Starting sexual intercourse at an early age

–  Viral infection, such as human papilloma virus (HPV), human immunodeficiency virus (HIV), or herpes   simplex virus (HSV)

–  Weakened immune system

–  Previous cancer of the lower genital tract

–  Smoking


When & how often should you have a PAP smear?

The best time to have a Pap test is when you are not menstruating. If you feel more comfortable with a female doctor, you can ask for one.

  • For 2 days before the test, avoid the following because these might hide any abnormal cells.

–  Intercourse

–  Douches

–  Vaginal medications (except as directed by your doctor)

–  Vaginal contraceptives such as birth control foams, creams, or jellies


The Latest Cervical Cancer Screening Recommendations

  • Women 21 and Under: No Screening Required (I disagree with this. While the risk is low it is present. Indeed I have seen girls as young as 17 with cervical cancer insitu. I would recommend screening commence 2 years after first sexual intercourse).
  • Women 21 to 29: Pap Smear Every Three Years. Thanks to an abundance of research, we now know that yearly Pap smears aren’t necessary for a majority of women. Why? First, disease progression – the time between the appearance of precancerous lesions and the development of invasive cervical cancer – is slow. Second, women’s bodies resolve some abnormal cellular changes on their own in time. Screening annually can increase the likelihood of unnecessary follow-up procedures, such as biopsies.
  • Women 30 to 65: Pap Smear Every Three Years; HPV Testing Optional.
  • Women 65 and older who are low risk for cervical cancer (women who have had regular, normal testing in the past) don’t need Pap smears or other screenings. Annual checkups, however, should resume. Women should also notify their doctors of any unusual symptoms, such as irregular bleeding, vaginal discharge or painful intercourse.

Pap smear should be done as part of a pelvic exam and should be accompanied by a breast exam performed by your doctor. It should only take a few minutes to perform a Pap smear.

Early cervical pre-cancers or cancer often have no signs or symptoms. Therefore, it is important for women to have regular Pap tests. Symptoms usually appear when the cancer is further along.

  • Report any of the following to your doctor right away:

–  Unusual vaginal discharge

–  Blood spots or light bleeding other than your normal period

–  Bleeding or pain during sex

These symptoms do not mean that you have cancer. They can also be caused by other conditions, but a check-up with the doctor is a must to find out.



Kim Patra is a qualified Midwife & Nurse Practioner who has been living and working in Bali for over 30 years. She now runs her own Private Practice & Mothers & Babies center at her Community Health Care office in Sanur.


Kim is happy to discuss any health concerns that you have and may be contacted via email at, or office phone 085105-775666 or

Copyright © 2019 Kim Patra

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