Since most cervical cancer is due to human papillomavirus, which is sexually transmitted, why do we tell women who have never had sex to start regular Pap tests at age 21?
—Teresa Beck, MD, Atlanta

Such organizations as the American Cancer Society recommend starting annual cervical cytologic screening three years after the initial act of coitus or at age 21. Since nearly all cervical cancer is a result of infection by human papillomavirus, it is reasonable to ask why screening should be performed in women not exposed to this virus. I do not perform Pap smears on women who have not had sexual contact with another person unless they have abnormal uterine bleeding or abnormal appearance of the ectocervix when visualized with a speculum.
—Daniel R. Mishell Jr, MD (116-25)

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