Pap or HPV test? What to know about cervical cancer screening

When it comes to screening for cervical cancer, you may be confused by recent articles about changing screening guidelines. Because each woman’s situation and risk factors are unique, your first step should be to talk with your gynecologist. Here’s some background on the available tests and recommendations that can help you start the discussion.

• What tests are used to screen for cervical cancer? There are two tests used to screen for cervical cancer—the Pap test and the HPV test. The Pap test, named for its inventor Georgios Nikolaou Papanicolaou, looks for precancerous cell changes on the cervix. The HPV test looks for high-risk strains of the human papillomavirus (HPV), which can cause these cells changes. Screening for cervical cancer is important, because when the cell changes are detected early, the 5-year survival rate is 92%.
• When should screening for cervical cancer start? Current guidelines recommend that women begin screening for cervical cancer at 21 and undergo a Pap test rather than an HPV test. That’s because HPV infection is common in this age group and most of these infections will clear up without treatment and will not cause precancerous cell changes in the cervix. If the test results are normal, the guidelines recommend a Pap test every three years until age 29 but ask your doctor if that schedule is appropriate for you. From age 30 to 65, your doctor may recommend a Pap test, an HPV test, or both, which is called co-testing and is recommended by the American Cancer Society, the American College of Physicians, and the American Congress of Obstetricians and Gynecologists. One benefit of co-testing is that studies have found that this approach has a lower rate of false negative results that Pap testing alone. If your doctor recommends co-testing and your results are normal, you may be able to wait 5 years before your next screening.
• Why is an annual Pap test no longer recommended? Changes to the cells in the cervix happen very slowly, taking more than a decade to become cancer cells. Annual testing may catch early cell changes that will never become cancer, leading to unnecessary treatment. In addition to being unnecessary, some types of cervical cancer treatment can weaken the cervix and may affect fertility or the risk of premature birth in the future.
• Are there any situations where more frequent testing is needed? Women with certain risk factors may need more frequent screening. Those risk factors include HIV infection, being immunosuppressed, being exposed to diethylstilbestrol (DES) before birth, and having undergone treatment for a precancerous cervical lesion or cervical cancer.
• Do women who received the complete series of HPV vaccines still need cervical cancer screening? Current vaccines don’t protect against all strains of HPV, so even women who have received the HPV vaccine should follow their doctors’ recommendation for cervical cancer screening.
• Are there women for whom cervical cancer screening is not recommended? Testing is not recommended for women younger than 21 and those who’ve had a hysterectomy that included the removal of the cervix (unless the procedure was to treat cervical cancer). Although guidelines recommend that women who have no history of cervical cancer or precancerous lesions can stop screening at 65, a new study suggests that continued testing may offer benefits, especially for African American women. In that study, researchers found that 20% of women with cervical cancer are diagnosed after the age of 65.