New guidelines in screening for cervical cancer include the option of HPV testing, a move that may soon signal the end for the Pap smear test.
Cervical cancer used to be a common cause of death among American women. Today, the American Cancer Society says, 13,000 American women are diagnosed with cervical cancer each year — and 4,000 will die.
Incomplete screening is the most common reason.
But adding the HPV test to the screening guidelines improves a woman's options, says Dr. Matthew Carlson, an assistant professor in the department of obstetrics and gynecology at UT Southwestern Medical Center.
"I think what we’re finding now is that testing for the HPV virus might be as good or better, and we may be setting the stage for just HPV testing down the road," Carlson said.
- Women ages 21-29 should get a Pap smear every three years.
- Women ages 30-65 can get an HPV test every five years, or a Pap test every three years, or a combination every five years.
- Women over 65 who have had recent clear tests probably don’t need testing anymore.
- Women under 21 probably do not need testing.
Why not offer the option to women 21 through 29? I think that has to do with the fact that younger women are more likely to have the HPV virus, and clear it, just because of the nature of earlier sexual intercourse and where they are in their lives; they may not be in a monogamous relationship. Also, most of these infections never cause any problems, so we could end up going on a wild goose chase for something that’s going to be self-limiting.
Why introduce the HPV option: I think what we’re finding now is that testing for the HPV virus might be as good or better (than the pap test), and we may be setting the stage for just HPV testing down the road.
Limitations of the Pap smear test: One of the limitations is that we’re actually looking at the cells, and that’s automated and is subject to interpretation sometimes. It can lead to unnecessary tests sometimes. The HPV is more objective – it’s positive or negative. The pap tests are more subjective - there are kind of degrees of abnormality they can see.
Is the end of the Pap test near? I think that’s where we’re headed. I think they purposely leave some leeway here, partly because there are some places that don’t have the infrastructure to go to HPV testing only. We’ve been doing the automated pap tests for so long, and then they were able to easily add the HPV testing for what we call co-testing. I think that to have a shift that abrupt to just HPV testing may be tough for some institutions.
- American Cancer Society: Cervical Cancer
- CDC: HPV
- New cervical cancer guidelines start making Pap smears obsolete
- Why some women may need cervical cancer screening even after age 65
- U.S. Preventive Services Task Force: Screening for Cervical Cancer in Primary Care
- National Cancer Institute: Pap and HPV Testing