Pap Screening Changes in Alberta

Alberta Health Services has made changes to Pap Screening procedures. Based on evidence regarding technology and on epidemiologic data, the revised guidelines no longer recommend annual screening for all women.

What is a Pap test?
A Pap test checks for changes in the cells of your cervix. It is done in a healthcare provider’s office and only takes a few minutes. An instrument called a speculum is gently inserted into your vagina so the cervix can be seen. Cells are carefully collected from the cervix and sent to the laboratory to be checked under a microscope. Alberta Health Services: Screening for Life will notify you with the results and direction for next steps by mail.

If ‘abnormal’ cells are found you will be directed to follow-up with you health care provider, who will monitor closely and, if needed, treat so that a cancer does not develop.

Until recently it was recommended that a woman begin having pap tests yearly from the time intercourse occurs.

What causes cervical cancer?
There are more than 45 types of human papillomavirus (HPV) that are transmitted by intimate sexual contact. Persistent infection with a carcinogenic type (about 15 types are) is necessary for cervical cancer to develop. Most infections resolve without symptoms or treatment. A woman’s immune system generally clears the virus where cervical cell changes have occurred. When the virus has not cleared persistent carcinogenic HPV infection may cause precancerous tissue changes that can progress to invasive cancer over many years.

Why the changes?
Widespread Pap testing over the past 40 years has resulted in a substantial reduction in cervical cancer mortality. As well, cervical cancer is rare in Alberta among females younger than 21 years old, and with the availability of the HPV vaccine it is expected that the rates of infection will continue to decrease.
Technologies in Pap testing, and HPV testing have evolved increasing accuracy.

However, “30% of Alberta women have not been screened for more than 3 years.”
(2009, Revised. Guideline Screening for Cervical Cancer. Retrieved from http://www.topalbertadoctors.org) Women who have never been screened or are screened irregularly are most at risk for cervical cancer.


What are the new guidelines?
You should have your first Pap test at age 21 or 3 years after intimate sexual contact, whichever is longer. From then; unless your healthcare provider tells you otherwise, you should have a Pap test once a year for 3 years. If the results of all 3 tests are normal, you can begin having Pap tests once every 3 years. For most women 70 years and older, cervical screening can stop if your last 3 Pap tests, done within the past 10 years, were normal.

You should still be screened even if you have received the HPV vaccine.

For women over 30 who have been found to have borderline cell changes on her Pap test, the sample may also be tested for high-risk HPV. This test helps decide whether the woman should go for more specialized tests. HPV testing is not recommended for women younger than 30.

Where can testing be done?
If you do not have a family physician you can call Health Link Alberta at 1-866-408-LINK (5465) to access a clinic.

How can the risk be reduced?
“Have Pap tests as per the Screening guidelines.
Talk to your healthcare provider about the HPV vaccine.
Even if you are vaccinated against HPV, get a Pap test regularly. The vaccine does not protect against all types of HPV that can cause cervical cancer.
Limit the number of sexual partners you have.
Use condoms. Although condoms work well to prevent other STIs, they offer less protection against HPV. HPV can be found on skin that is not covered by condoms.
Don’t smoke and limit exposure to second-hand smoke. Tobacco use in women with HPV has been linked to a higher risk of cervical cancer.
Understand that sexual activity at a young age increases your risk of being infected with HPV.” (2009, Cervical Screening: Do I Really Need a Pap Test? Retrieved from http://www.screeningforlife.ca/_files/file.php?fileid=filelhfBSETAJA&filename=file_AHS_CERVICAL_Important_Pap_LowR.pdf)

Reference Sources:

http://www.topalbertadoctors.org/informed_practice/clinical_practice_guidelines/complete%20set/Cervical%20Cancer/cervical_cancer_guideline.pdf

http://www.screeningforlife.ca/cervical/index.html

Disclaimer:
Decisions about particular medical tests and treatments should always be made in consultation with a qualified medical practitioner knowledgeable about women’s health and STI’s / HIV. Information accessed through or published or provided by AIDS Calgary, is not to be considered medical advice.