The END of the YEARLY SCREENING PAP SMEAR:
HPV Tests with Pap in women over age 30 / Changed pap intervals for all age groups / NEW Recommendations from the American Congress of Obstetricians and Gynecologists
In gynecology, the HPV test and pap smear are often being used together to help us detect cervical cancer and pre-cancer. Human papillomavirus (HPV) is a very common virus easily spread between people, and is implicated as the causative agent of cervical cancer over a period of many years. Using the HPV test along with a pap in women over 30 is becoming commonplace in routine cervical cancer screening. Together, the two tests tell us even more in-depth information about a woman’s risk for cervical cancer. A woman over 30 may be screened for cervical cancer with a regular pap smear, or with a PAP PLUS HPV test.
In a woman over 30, if both the pap test is NORMAL, and the HPV test is NEGATIVE, that woman is at such a low risk for cervical cancer that a cervical cancer screen/pap can be deferred for 5 years. A normal pap alone means the screening interval may be stretched for 3 years. Cervical cancer screening intervals have also been changed to every 3 years for women in their 20’s. A pap is not normally done before age 21, and is not recommended routinely after age 65. Gynecologists will not commonly use a screening pap in a woman who has had a hysterectomy for a reason other than cervical cancer. (Please note that an annual physical exam, including a pelvic exam, is still recommended, even if a pap is not needed that particular year.)
An abnormal pap is evaluated at once, because abnormal cells usually mean that HPV has already caused pre-cancerous changes to occur on the cervix, and your physician needs to make sure that the abnormal cells do not need treatment to prevent the development of cervical cancer. If the cells of your pap smear are abnormal for the first time, you can expect a call from our office to notify you and discuss further recommendations.
However, a normal pap in the presence of POSITIVE HPV is a more grey area. Since HPV infection is so common, and usually transient, performing cervical biopsies on every person positive for HPV would be troublesome for women. For most women, the HPV infection will be gone by the next year, without causing any harm to the cervical cells. It is for this reason that a test of this type is usually repeated in one year. Even if the pap is normal the next year, if the HPV still persists, your physician may recommend further evaluation of your cervix, to ensure that no cervical pre-cancer exists.
Using the pap and HPV tests together together is a better way to test which people are at the highest and lowest risk for cervical cancer, and ensures that we don’t miss patients with cervical cancer/pre-cancer even if one test is falsely negative. The HPV test added to the pap will have a positive impact on the lives of women, decreasing cases of cervical cancer since pre-cancer can be detected more accurately. Of course, the pap test results and screening intervals now become harder to explain, and that’s why I’ve written out this information. If you still have unanswered questions about HPV and pap smears, I’ll be happy to answer them.
Paps have saved many lives from cervical cancer, but the HPV vaccine which is now being given to young women will have an even greater impact on reducing the risk of cervical cancer among women. If you have a young woman in your life, please ensure she has received the HPV vaccine.