Published Jun 11, 2014, Everyday Health
In developing countries, where Pap tests are not done, cervical cancer is still the leading cause of death among women aged 35 to 45. In the United States, the cervical cancer rate has been extremely low since the 1960s, when annual Pap smears were introduced, which is why for most women, the ritual of the annual Pap test is reassurance that all is well in gyno land.
But over the last few years, a number of different pap protocols have been recommended, and this has been, to say the least, confusing. Depending on your age, which test is being administered, and your personal history, you might need a Pap test annually, or every two years, or every 3 years or every 5 years… or not at all.
And now the FDA has come out with a unanimous recommendation that the traditional Pap test should be replaced with a specific high-risk human papillomavirus (HPV) test in order to determine who is most likely to have true pre-cancerous or cancerous changes. Why the change?
What’s Behind the New Recommendation for HPV Testing
Keep in mind that HPV, the cause of cervical cancer, is extremely common; some studies show that it is present in the cervixes of almost 80 percent of sexually active women. There are over 40 subtypes of genital HPV; but only about 10 percent of women infected with high-risk HPV develop a persistent infection, which may put them at risk of cancer. Most HPV gets cleared and has no consequences.
More likely than not, you are one of the women who has received that stomach-dropping phone call, “Your Pap test is abnormal, and you need to come back for further testing,” only to ultimately be told that you did not have cancer. And despite the reassurances that the most likely outcome is that everything is fine, it didn’t make up for the weeks of waiting, the fear of cancer, and the discomfort (and expense) of a colposcopy and biopsy to find out that all was well.
If they’re tested for high-risk HPV first, instead of having a traditional Pap test first, the majority of women who have nothing wrong with their cervix won’t have to go through a lot of additional testing to determine if there is an actual problem.
Specifically, the new recommendation is that, starting at age 25, women should get a cervical swab to check for HPV. If a high-risk HPV (16 or 18) is detected, proceed with colposcopy. If one of the other HPV strains is detected, do a traditional Pap that looks at the cells on the cervix, and then do a colposcopy only if there is evidence of pre-cancerous changes.
While this new HPV test certainly has advantages, what is increasingly clear is that strategies to prevent invasive cervical cancer need to focus on two fronts:
- HPV Prevention. The HPV vaccine and practicing safe sex are critical to preventing infection with the virus, which is also responsible for vulvar, vaginal, anal and even oral cancers. Mid-life women are particularly vulnerable since they are less likely to use condoms in a new relationship and are also less likely to clear the virus. There are many strategies that will allow you to have a positive sexual experience without testing positive, and my book Love Sex Again, goes through the details.
- Cervical Cancer Screening. While this new HPV protocol does offer an advantage, the majority of the 12,000 women in the United States women who develop cervical cancer each year didn’t have the “wrong” test. The majority of the women who develop cervical cancer had NO test. Having different recommendations for specific tests and intervals between testing is confusing for patients and doctors and can result in women not getting appropriate testing.
What’s the Answer? Get Screened
In a commentary published in this month’s Annals of Internal Medicine, authors Rebecca Perkins, MD, and Elizabeth Stier, MD, from Boston University School of Medicine agreed and emphasized that any screening is better than NO screening.
So here’s the bottom line:
If your doctor is not offering this new HPV test, not to worry. The most important thing is to get screened, with any test your doctor offers.
And yes, you do need to see your gynecologist even if it is not a “Pap test year.” Even if you don’t need cells sampled from the cervix, your gynecologist (or other healthcare professional) still needs to put a speculum in and take a peek inside to make sure your cervix and vagina look healthy. Face it, who else is going to look in your vagina?