Why you need to stay up-to-date (no matter what your age)!
In my gynecology practice, I have seen a lot of women put off pelvic health exams and labs like Pap smears. Sometimes they are just too busy, distracted by a hectic life, kids and careers. Sometimes it may be intentional, as a lot of women may feel “all is well” so maybe the appointment can be put off a year or longer. Certainly I recognize that these appointments aren’t a woman’s idea of a fun time.
But I also find that women may think—or even have been told—that they no longer need an annual pelvic exam or a routine Pap smear, either due to their age, having had a hysterectomy, or the fact that they are not sexually active at the moment.
As a longtime OB-GYN, I have found that regular pelvic exams and Pap smear testing—for women of all ages and stages—can be two of the greatest preventative tools doctors have in the early detection of cervical and other vaginal cancers. Not having a Pap smear within the last 3 years has been found to significantly increase a woman’s risk for cervical cancer. In fact, not having that screening is actually the highest risk factor (82.4 percent) there is. (1)
There is a lot of data that supports that less regular screening results in fewer detections allowing cancers to progress. One shocking statistic from several years ago really underscores this point. After the Covid lockdown (obviously, women got behind on these important screenings and took a while to catch up), one study found there was a 75.5 percent decrease in screenings with a corresponding decrease in newly diagnosed cancers of 45 percent along with a 17 percent increase in late-stage cervical cancers. (2)
The good news is that statistics also tell us that for these types of conditions, early detection means they most often are fully treatable.
So we need to stay up-to-date…and catch up if necessary!
But what if you’ve been told you don’t need a Pap smear anymore? Maybe your doctor has even cited the current American College of Obstetricians and Gynecologists (ACOG) guidelines for Pap smears (also what your medical insurance will typically cover) which say that young women under the age of 21 as well as older women over the age of 65, or women having had a hysterectomy, generally don’t need this vital and simple test.
If you’ve been told this, I want you to know that I and many of my peers disagree with this rigid concept of “one size fits all” guidelines. The guidelines and insurance coverages need to be changed. A woman’s risk for cervical cancer is very individual to her overall health (not just her age) and her sexual history as well as her current lifestyle and immune system status.
I’ve personally had patients over 65, post-menopausal or who have had a hysterectomy, which had been told that they no longer needed to be screened with a Pap smear, who have then later been diagnosed with cervical cancer.
Years ago, in fact, I was heartbroken when a 72-year-old friend of mine was diagnosed with having aggressive cervical cancer. At age 60 and post-menopause, she had been told she no longer needed Pap smear testing based on the standard guidelines. She had always been extremely active and fit, ate healthy, balanced her hormones with therapy, exuded vibrancy, and was still sexually active.
According to the guidelines, she was not at high risk for cervical cancer… so no one bothered to offer her pap smear testing or annual pelvic exams.
When she had some vaginal bleeding later on at the age of 70 she was still not given a Pap smear. The bleeding had been viewed as an outcome of her post-menopause-related hormone prescription changes so her hormone therapy was simply fine-tuned. When the bleeding returned a few months later, she was diagnosed with advanced Stage 4 cervical cancer and referred to oncology. My friend came to me for help. I of course did a pelvic exam along with other testing, and added on integrative therapies and supplements to her chemotherapy regimen, along with oncologist's approval. Some of what we have started is IV immune boosters, IV Ozone and vaginal ozone, IV high dose vitamin C while fasting, prescription metformin - which is an insulin sensitizer, Oncoplex ES (SGS) Immunotix (by Xymogen), methylated folate, melatonin, prescription methylene blue, as part of the core regimen along with daily prayer, meditation and gratitude practice.
She is now doing amazing and much much better than expected, enjoying her friends, and feels very empowered. We don’t know what the future holds and are optimistic. However, it is so incredibly sad and frustrating as it was entirely avoidable had it been caught early on.
The bottom line is that a given woman’s “need” for a Pap smear is not as simple as being too young or too old to warrant screening. It’s not as simple as whether you are in menopause or post-menopause. It’s not as simple as whether you’ve had a hysterectomy (even if you no longer have a cervix). There are other risk factors that are very individual to every woman. I’ll be talking more about the risk factors you need to consider in a moment.
Just remember: You can’t prevent cervical cancer progression without testing!
Women may know they have routinely gotten a Pap smear throughout their lives, but not everyone understands the true importance of what Pap smear results can tell us.
It’s not just about learning, “Yes, you have cervical cancer or no, you don’t.”
Yes, it can detect cervical and other vaginal cancers. But perhaps more importantly, a Pap smear can detect potential precancerous cervical changes before cancer even develops. And because the timeline from a precancerous stage to cancer is slow, routine screening can make cervical cancer a preventable disease.
I hate the name Pap smear, as it just doesn’t alert women to how important it can be! Why not call it a cervical cancer screening or something more meaningful?
Well the name has to do with the inventor of the screening test, Dr. Georgios Nikolaou Papanikolaou. In the 1920’s while studying how smears of vaginal secretions could be used to time women’s reproductive cycles he found that he could identify cancer cells in the smear. This eventually led to a book in 1943 discussing his landmark test, a simple and inexpensive way to identify cervical cancer and precancerous cervical dysplasia.
Annual Pap smears quickly became the norm for women, and the screening reduced cervical cancer deaths by some 70 percent over the past 50 years (according to the American Cancer Society). (3) So, I guess the good doc deserved the test to be named after him after all.
During a Pap smear, a doctor swabs the cervix (the area between the upper part of the vagina and the lower uterus), and the cells in that sample or smear are studied under a microscope. A Pap smear isn’t painful but may be briefly uncomfortable. The worst part is often the cold speculum, which is what is inserted into the vagina to obtain the smear.
A woman can have “normal” (no cancer or precancerous cervical changes found) results or have one of several “abnormal” or inconclusive outcomes indicating more testing is recommended.
Sometimes after an abnormal test, a second Pap smear will come back with normal results (perhaps due to a woman having a yeast infection or other issue going on during the first test).
Abnormal results can identify a variety of infection-causing microorganisms including herpes virus, candida species (yeast infection), cytomegalovirus (infection of the cervix), trichomonas vaginalis (a sexually transmitted disease), and actinomyces species (rare, brought on by IUD infections). (4-7)
Abnormal results can also identify precancerous cell abnormalities (cervical dysplasia) or cervical cancer itself.
Cervical dysplasia is often triggered by a woman having some high risk strain of sexually transmitted Human papillomavirus (HPV). These higher risk strains of HPV (a few are known as HPV 16, 18, and 33) are responsible for some 99.7% of cervical cancers. (8)
Remember, cervical dysplasia is a “heads up”, not a cancer sentence. Even if you have cervical changes that indicate cervical dysplasia that only means you may – not that you will – develop cervical cancer.
Like I said earlier, cervical cancer takes a long time to develop (3 to 7 years according to ACOG) and there are many treatments that can resolve the dysplasia (which is why cervical cancer screening is so important). (9)
If cervical dysplasia is identified in the Pap smear, additional testing may include an HPV test (to specifically identify high-risk types of the HPV virus) or a colposcopy (an exam that allows a doctor to look more closely at the cervix). Depending on what is found, a doctor may then recommend further treatment. The earlier the diagnosis for dysplasia the better the outcome. We can often reverse it completely.
Since most pre-cancerous diseases of the cervix – as well as cervical cancer – are rooted in having the HPV virus, I think it is worthwhile talking a bit more about HPV infections. I’ve found that many of my patients in longer-term relationships have never given a thought to HPV. But it is very common.
About 80 percent of women have an HPV infection on at least one of their Pap screenings at some time in their lives. Mild strains of HPV infections cause changes to cervical cells but often go away on their own. Most of the time the body’s immune system can clear the virus from the body (in about 2 years according to ACOG). (10)
HPV infections, however, can linger on in some women. Having a weakened immune system is one of several risk factors that can cause some women to develop cervical dysplasia after an HPV infection while other women won’t. (11)
It is worthwhile noting that there is an HPV vaccine (Gardasil® 9, licensed in the US in 2014), which is recommended to be given around the age of 9.But I have a lot of concerns about this vaccine.
There have been a number of studies from several different countries showing vaccinated females experienced a variety of adverse reactions from HPV vaccines including dysautonomia (problems with the involuntary nervous system which can be expressed in heart and blood pressure issues, loss of bladder control and trouble breathing), involuntary movement, weakness in the limbs, chronic pain, abnormal autoimmune reactions, chronic fatigue syndrome, and a number of neurological effects.
While the studies have found that serious adverse reactions are few there are enough concerns that HPV vaccines remain controversial. There are also unknowns as to how long the protection even lasts with limited studies showing only one vaccine (Cervarix, which is no longer available in the US) lasting for 11 years. Studies on the vaccine’s longer-term effectiveness and side effects need to be undertaken.
I also want to make sure women understand that HPV vaccines do NOT even protect against all strains of HPV that can lead to cervical cancer, so HPV vaccines are NOT a substitute for regular ongoing Pap smear testing. (12,13)
Every woman needs a pelvic exam on a regular annual basis throughout her entire life. Your doctor should look at the color and health of the tissue; whether there is thickening, lesions or masses; feel for bumps or warts; look for blood, and check to ensure there isn’t any pain associated with your vagina, cervix, uterus or ovaries. This exam should be covered by most insurance as a preventative procedure.
It is also my professional opinion that women need a Pap smear every 2 to 3 years (max), depending on their own unique set of risk factors. I view this as testing that once started should continue throughout a woman’s life.
You can review the ACOG guidelines for Pap test screening, which look at age, previous Pap and HPV test results, and certain health markers such as having HIV, HSV-2, and chlamydia trachomatis.
As mentioned, the guidelines are pretty much one size fits all but I’ve added some points below you may want to consider if you are being told, “You no longer need screening.” Each of us needs to look at our own risk factors and make the best decision for our own health and peace of mind!
Young women or even adolescents should be tested with a Pap smear if sexually active, even if under ACOG’s guidelines of age 21. After that testing should occur at a minimum of every 2-3 years depending on what’s going on with that individual’s health and sexual activity (HPV risk), and assuming a negative HPV result.
Women having had a hysterectomy (even if cervix removed) should be tested as there can still be cancerous cells at the top of the vagina. For my patients, I will do a pelvic exam and swab the cervical cap and submit the Pap smear for screening. I will do pelvic exams regularly, offer pap smear depending on risks and insist on pap smear if it has been greater than 3 years since the last one, has ever had an abnormal pap, or has a new sexual partner or auto-immune disease. This goes for all women.
Women over the age of 65 or post-menopausal should still be given a Pap smear every 2 to 3 (max) years, depending on their health and other risk factors. Just think of my 72 year old friend and my many older or post- menopausal patients! Especially if you are sexually active, even with a single partner. You have to think about what infectious history that one partner brings along to you (they may have had multiple partners and/or HPV). There are also many other risk factors that affect ALL aged women that are clearly not considered in the ACOG guidelines in this 65+ age category such as: being immunocompromised (I’d include autoimmune diseases in here as well as women dealing with chronic stress), high parity (having had multiple pregnancies), having poor nutrition, smoking, obesity, and having certain underlying inflammatory diseases. (14) How can the guidelines truly say that older women don’t need to be screened?
Pregnant women should be screened.
Transgender men as well as non-binary people having a cervix, should be routinely screened as well.
Seriously, given that it is a simple test and knowing the statistics when screenings aren’t done, I always recommend my patients continue to get Pap smears and pelvic exams on a regular basis throughout their lives.
Sometimes that may mean paying out-of-pocket, going to a clinic, or working with your doctor to try and get you the test through your insurance provider.
The cost of a Pap smear will differ according to where you live but most Pap smears – if paying out of pocket – shouldn’t cost more than $50 - $150. That doesn’t include the pelvic exam, but that should be covered by insurance if you have that (and you need to have an annual pelvic exam!). The Centers for Disease Control and Prevention (CDC) maintains info on free or low cost screenings. Here is the link: https://www.cdc.gov/cancer/nbccedp/ where you can also find eligibility information.
Most community health organizations can also direct you to low cost screenings.
The ACOG guidelines mention that if a woman has a “compromised immune system” that the one-size-fits-all guidelines don’t apply as she is at higher risk for cervical cancer and needs more thorough testing.
But what “compromised immune system” means is a bit subject to interpretation.
There are a lot of things that can compromise an immune system.
Perhaps you are immunosuppressed as a byproduct of years of a stressful pandemic or even possibly due to having—or still having—so many Covid immunizations (vaccinations can tax the immune system). Research has even suggested that having had Covid may indirectly impact HPV-infected cervical dysplasia as the Covid virus may preoccupy and weaken the body’s immune system favoring cervical cancer disease progression. (15)
We know from other research that post Covid there has been more reactivation of the varicella-zoster virus (the virus that causes chickenpox and then lays dormant in the body, potentially reactivating later as shingles). (16) One study found that people having Covid experienced a 15 percent higher chance of shingles (or 21 percent in those who were actually hospitalized with Covid). (17) And in still other research, there was increased reactivation of the Epstein-Barr virus (EBV – the virus causing mononucleosis) after having Covid. (18) Clearly Covid and other viruses can compromise a woman’s immune system.
And it isn’t just viruses. Chronic stress is a key offender that affects many women’s immune system health. (19)
I find that a weakened immune system is very common in most of my patients and clients; that’s why boosting immune health is one of the initial areas of focus in my women’s restorative health programs. Along with family and work stress there also seems to be no end to today’s societal and political stressors (and we all understand the stress of simply affording groceries and paying our bills these days).
There are usually no symptoms of precancerous activity. That’s why you need to do preventative screening.
Remember my 72 year old friend? She did have some bleeding but that was misread as hormone imbalance due to menopause. There are a few other possible symptoms but they can be attributed to a lot of other things as well.
Sometimes as cervical cancer progresses we might see:
Vaginal bleeding after menopause or between periods
A watery and bloody discharge with a foul odor
Heavier menstrual bleeding that lasts longer than usual
Pain during intercourse or pelvic pain
Bleeding after intercourse
We really need to do the testing so we’re not guessing what might be going on
Receiving abnormal results means that you and your doctor now know there is a problem so you can begin to focus on resolving it (thus preventing its progression to cancer).
Sure, abnormal results can be scary. But they do provide you an early alert so that’s a good thing. You can now get additional testing to see what specifically is going on and you can also engage in some immune boosting activities to support and strengthen your body’s immune system.
I have actually been recommending a protocol to my own patients for many years focused on resolving cervical dysplasia.
I initially created this protocol when I had a 23 year old patient come to me with aggressive vaginal warts. She had so many warts that I was going to have to remove them with a laser. I scheduled the surgery, but in the meantime recommended some natural protocols that I had read about in the literature that I thought could possibly help improve her immune health and condition.
One of those protocols came from some research from John Hopkins focusing on sulforaphane. (20)
Sulforaphane is a chemical byproduct of chewing cruciferous vegetables such as broccoli sprouts, cauliflower, and broccoli. These types of veggies contain a chemical called glucoraphanin which enzymatically converts to sulforaphane as a result of enzymes released when chewing.
The John Hopkins research concluded that sulforaphane provided immune system support and antioxidant activity as well as producing detoxifying enzymes. Subsequent research confirmed that sulforaphane also has anti-cancer, cytoprotective, immunostimulant, cardioprotective and anti-inflammatory attributes as well. (21,22)
I found a wonderful Xymogen product containing glucoraphanin called Oncoplex™ that is based on broccoli seed extract. The broccoli seed contains glucoraphanin, which enzymatically converts to sulforaphane. I also gave my patient methylated folate supportive of immune health and detoxification. When my patient came back 4-6 weeks later for her pre-surgical consultation all the warts were gone. She no longer needed any surgical intervention. After that, I started using this protocol any time a patient or client had a Pap smear or biopsy showing cervical dysplasia. In every case, I would get a normal Pap smear within about 4-6 months.
I’ve now packaged Oncoplex, and many other important nutrients for immune support, in my Superwoman Daily Dose Packs. These packs include so much more than simple immune support, including digestive, detox, joint support… and all of the most helpful nutrients a woman should take each day. You can watch this video to hear why I use these, too. I am a Superwoman after all, just ask my daughters!
Final thoughts on cervical cancer prevention
I hope this article helps empower all of you in our Girlfriend Community to protect your health and prompts you to get caught up on your regular Pap smear screenings. Early detection will reduce your risk for cervical cancer.
I want you to be empowered with your preventative health. Talk with your doctor about your concerns; you are the CEO of your health.
Additionally, along with regular screenings and an annual pelvic exam by your doctor it is important that you know your own anatomy. You are your first line of defense (or offense, as you are being preventative). I often will say, “Grab a mirror and take a little tour of your downunder!” Women should know what their “normal” feels like down there. What are the normal secretions you have throughout the month? Is everything smooth or do you feel bumps or lumps? Is there any pain? If you discover any changes, such as pain, discharge, bleeding, changes in the color, size or shape of warts on the genitals, etc. you should see your doctor for a further evaluation.
Practicing safe sex, eating a healthy Alkaline, Keto-Green diet, maintaining a healthy weight, limiting alcohol consumption, quitting smoking, and reducing stress can also help you reduce your risk of cervical cancer.
Finally, I hope you see how focusing on strengthening your immune health is so important. You can learn a lot more on my blog, including easy (fun!) ways to boost your immune system health by focusing on immune boosting activities that improve your sleep, stress resilience and connections.
Don’t forget to share this important information with your girlfriends. I also recorded a podcast on this topic that you can share, find it here. And if you have any questions about Pap smears, please send an email to my support team at: team@drannacabeca.com
