Counseling patients about annual Pap smears
Asking certain questions could help ensure that patients understand the difference between a Pap smear and a pelvic exam.
Recently, a publication in Cancer suggested that the mortality rate from cervical cancer is actually higher than previously believed. The article also discusses the fact that the mortality rate is highest in the elderly African American population. Therefore, it is suggested that an effort be put forth to ensure adequate screening is performed on these individuals.
I find this article interesting because I am always concerned about the efforts to encourage women to receive proper screening. What I find most interesting is that some women I encounter, particularly younger women, think that they are getting proper screening when they actually are not.1
Whenever I perform a pelvic exam, I ask my patients if they get routine Pap smears. Usually, the women say yes and I continue with my exam. It wasn't until I had a patient say, “Yes, I had one last year when I was here,” that the alarm bells went off in my head.
“You had a Pap smear in the emergency department?” I asked. “Yes,” she responded, “I was here last year for the same symptoms and they did an exam.”
This seemed odd to me, so I completed the pelvic exam, left the room, and accessed the patient's chart. As I suspected, the patient had a pelvic exam in the emergency department the year before and cultures were obtained for gonorrhea and chlamydia testing, but no Pap smear was ever performed. I went back in and talked to the patient, explaining to her that a Pap smear was not performed. I explained that she had a pelvic exam and was tested for certain infections, but this testing did not take the place of a routine Pap. We then went on to discuss the importance of following up with an Ob/Gyn doctor on a yearly basis.
I realized that this patient either did not know what a Pap smear was, or she assumed that any time she was getting a pelvic exam she assumed that she was getting a Pap smear performed too.
Since talking with this patient, I have now altered the way I ask questions when performing pelvic exams. I ask my patients when the last time they saw an Ob/Gyn was. I ask if they know whether they had a Pap smear when they were there, ask how often they see their Ob/Gyn, and I even describe the brush that is used to perform a Pap smear. After asking these questions, I learned that a lot of women are not following up with the Ob/Gyn for routine exams as they are supposed to.
We see a lot of women in the emergency department, many of whom are seen for pelvic complaints on a yearly basis. I want them to know that just because someone is performing a pelvic exam and looking at their cervix does not mean this should substitute for an Ob/Gyn visit.
I hope that counseling patients on the difference between a Pap smear and a pelvic exam will help them realize the importance of needing to follow up with an Ob/Gyn for an annual visit. Although we perform tests in a pelvic exam, this does not mean we are screening for HPV. I hope that arming women with this knowledge will encourage them to follow up with their Ob/Gyn to get the appropriate screening they need.
Jillian Knowles, MMS, PA-C is an emergency medicine physician assistant in the Philadelphia area.
- Beavis AL, Gravitt PE, Rositch AF. Hysterectomy-corrected cervical cancer mortality rates reveal a larger racial disparity in the United States. Cancer. 2017. doi: 10.1002/cncr.30507