Pap tests are a central part of sexual health for Canadians and keeping up with screenings is crucial to catch any early signs of cervical cancer, according to health professionals.
But misconceptions about why and how often pap tests are needed may cause some people to miss their tests.
It’s important to understand the purpose of the procedure and to make time for it in your schedule, said Elizabeth Holmes, manager of health policy at the Canadian Cancer Society.
“We get busy, and we’re just like: ‘oh I did it a couple of years ago, it’s fine,’” she said. “But it is really important to do it through your cervical cancer screening program to and do it every two to three years so that we can keep an eye out for abnormal cells,” she explained.
Generally, depending on the province or territory you live in, practitioners will recommend you plan for the screening every two to three years, said Holmes.
“Think of it as a part of your self-care, as part of taking care of yourself to check off your list,” she said.
“And if you haven’t had a great experience, then find a doctor you’re comfortable with and be sure to share your past experience with them, about why you’re nervous about it.”
Why are pap tests needed?
The purpose of a pap test is to screen for signs of cervical cancer by detecting cell changes in the cervix, said Dr. Rachel Spitzer, an obstetrician and gynecologist at Mount Sinai Hospital and Women’s College Hospital in Toronto.
“Pap smear screenings are usually for people who don’t have any symptoms or problems,” said Spitzer, who’s also an associate professor at the University of Toronto.
The development of cervical cancer is usually directly related to the human papillomavirus (HPV), explained Spitzer. “It’s looking for usually HPV-mediated … changes to the cells of the cervix long before cancers develop, so they can be treated and prevented,” she said.
In Canada, 1,350 women were diagnosed with cervical cancer in 2019 and an estimated 410 will die from it, according to the Canadian Cancer Society. But scheduled pap tests and the HPV vaccine are ways to prevent the disease, according to the society.
“A very important part of all of this message is recommendation around vaccination for ,” she said. The vaccine is usually available in schools, but adults can request the vaccine from their doctor — which may or may not be covered by insurance.
“Most people don’t know that HPV is what causes cervical cancer,” said Dr. Amanda Selk, an obstetrician and gynecologist based in Toronto. “And now we have a vaccine … and that can actually prevent you in life from ever getting the virus, which can help you for not getting cancer.”
At what age do I need a pap test?
The age when a first pap test is recommended, and how often the tests should be, depends on where you live in Canada, said Selk.
“The standard is, not before 21 and you have to have been sexually active. So if you’ve never had any sexual contact of any kind then you can wait,” she explained.
Some provinces, like Alberta and B.C. have raised the age for a first screening to 25, and that is also under consideration in Ontario, P.E.I. and NL.
This is due to new guidelines from the Canadian Medical Association Journal in 2013 that found the likelihood of false positives is higher if the patient is younger.
Testing also occurs every three years, instead of annually, in provinces like Ontario, as evidence shows that over-testing can lead to over-treating, said Spitzer. Doing too many “destructive” procedures to the cervix isn’t necessary and could impact future pregnancies, she explained.
Check with your doctor for the guidelines in your region and understand that sexual contact doesn’t only include vaginal sex, she added.
“Sexual activity is also sort of defined broadly. It’s not just penetrative sexual activity, it can be digital, and it’s not only between men and women, it can be same-sex,” she said.
Anyone with a cervix needs to have routine pap tests if they are sexually active, she explained. “So transgender men as well.”
“Sometimes the populations that are most at risk of coming forward with diseases that are well beyond the point where we should have been catching them are people who … are sort of marginalized or have a harder time connecting with the healthcare system,” she said.
Access to cervical cancer screenings for marginalized people continues to be a problem in Canada, as Black women are chronically under-screened for cervical and breast cancers and there’s a lack of data on the issue, according to a literature review from the University of Toronto.
Indigenous people continue to face issues like lack of access to culturally competent health care, and providers overall, according to Cancer Care Ontario.
What age you should get a pap test, by province, according to the Canadian Cancer Society:
- British Columbia: Testing starts at age 25, with subsequent testing every three years thereafter. Tests stop at age 70.
- Alberta: Testing starts at age 25, followed by testing every three years. Tests stop at age 69.
- Saskatchewan: Testing starts at age 21, or three years post first sexual contact, whichever comes first. Testing happens every two years until you have three negative tests in a row, then every three years. Testing stops at age 69.
- Manitoba: Testing starts at age 21, with tests every three years. Testing stops at age 69.
- Ontario: Testing starts at age 21 if the patient is sexually active. Testing occurs every three years and stops at age 70 with adequate negative screening history.
- Quebec: Testing starts at age 21 (there is no organized screening program). Tests occur every two to three years and stop at age 65 if the patient has had two negative tests in the previous 10 years.
- New Brunswick: Testing starts at age 21, or three years post first sexual contact, whichever comes first. Annual testing occurs thereafter, until there are three consecutive negative tests; then testing occurs every two to three years. Testing stops at age 69 if the patient has had negative tests in the last ten years.
- Nova Scotia: Testing starts at age 21, with tests every three years. Testing stops at age 70.
- Prince Edward Island: Testing starts at age 21 if the patient is sexually active. Testing occurs every two years and stops at age 65 if the patient has a history of negative screenings.
- Newfoundland and Labrador: Testing begins at age 21. Testing occurs annually until three consecutive negative tests in a row, then testing occurs every three years. Screenings stop at age 70 if patient has a history of negative screenings.
- Yukon: There is no organized screening program and no data available.
- Northwest Territories: Testing starts at age 21 (there is no organized screening program). Tests occur annually until three consecutive negative tests, then testing occurs every two years. Testing stops at age 69.
- Nunavut: Testing starts at age 21 if the patient is sexually active. Testing occurs every three years and stops at age 69.
When do I stop getting pap tests?
Typically, health care providers say you can stop having regular pap tests around the age of 69 or 70, depending on what province or territory you live in, said Spitzer.
“If your test results have been normal and if you’ve been screening at normal intervals, in most jurisdictions, your testing stops by the age of 70,” she said.
Testing may go beyond the age of 70 if you’ve had abnormalities in the last 10 years, or if you’ve had pre-cancer cells removed before, explained Selk.
What if a pap test makes me uncomfortable?
Cervical cancer is preventable if you engage with regular testing, and rates of that type of cancer in Canada are generally low because of pap tests, said Selk.
“It’s very important for patients to tell us, if they’re anxious or… anything that we can do to make it easier for them, whether it’s that they put the speculum in themselves to go really slowly, that sort of thing. We can try to make it more comfortable,” Selk said.
Doctors can’t predict how a test might make you feel, so it’s important to communicate any bad past experiences to them so they can make the process easier, she explained.
What are unusual signs and symptoms I should watch for?
As a pap test is meant for those who haven’t had any unusual symptoms, if you have issues like irregular bleeding, an abnormal or foul-smelling discharge, you should go to your doctor, said Spitzer.
“Very often a pap smear is not the test that is going to help figure out what’s going on with them in those circumstances,” she said.
Pain or bleeding during intercourse is something your doctor should check immediately, and you shouldn’t wait for your next pap test, said Selk.
“Even if you’re embarrassed, it’s very important to make sure someone sees you, looks at things and checks that things are okay,” she said.
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