Editor’s Note: In August 2018, the U.S. Preventive Services Task Force updated their recommendations to allow patients 30 to 65 years of age to receive HPV testing alone every five years — without an additional Pap test.
Almost 80 years ago, Dr. George Papanicolaou developed a simple test, the Pap test (also called the Pap smear), done in a doctor’s office to check for cervical cancer. During a pelvic exam, a doctor swabs a small sample of cervical tissue and looks for abnormal cells. If these precancerous cells are detected, it will lead to more tests or other more invasive treatments such as a colposcopy (in which actual tissue may be removed). In the 1930s, when Papanicolaou was developing his test, cervical cancer was more lethal than breast cancer. But since the development of this test, the number of women dying from cervical cancer has dropped dramatically. In 2009, of the 4,000 women in the United States who died of cervical cancer, most had never been screened or had not been screened in the 10 years before their diagnosis.
This year, the U.S. Preventive Services Task Force recommended less frequent Pap testing.
Cervical cancer is most common in women between ages 35 and 55, and usually develops from a human papillomavirus or HPV infection. Not all HPV infections lead to cervical cancer, and it can take decades for a persistent infection with a high-risk type of HPV to become cancer. High-risk HPV types are sexually transmitted and can lead to cervical cancer and also anal, penile, and oral cancers.
There are two types of screening: Pap tests and HPV tests. While they both require a pelvic exam in which cells are taken from the cervix, Pap tests look for abnormal or precancerous cells, and HPV tests look for DNA or RNA from high-risk HPV types in cervical cells. Both tests are used to try to catch cervical cancer in its earliest stages so that it can be successfully treated.
Most women expect their annual exam to include a Pap test. This year, all that changed. In March 2012, the U.S. Preventive Services Task Force (USPSTF) released the results of their study based on the pros and cons of the annual Pap test. Looking back over the scientific research, annual Pap tests have not been shown to dramatically increase the number of cervical cancers prevented.
The USPSTF is an independent group of national experts in prevention and evidence-based medicine. They look at science and research, include public comments on their drafts, and issue a recommendation. They do not consider cost in their recommendations. These new recommendations were also endorsed by the American Cancer Society and other professional organizations.
This is what they now recommend for people with cervixes:
- those who are 21 years old and under do not need to have a Pap test
- those who are under age 30 should not have HPV tests
- between ages 21 and 65, Pap tests should be done every three years or every five years if you have a Pap test and an HPV test at the same time
- Pap tests are not necessary for those over age 65 who have had adequate prior screening and are not at high risk for cervical cancer
- Pap tests are not necessary for those who have had a hysterectomy (which entails the removal of the cervix) and who do not have a history of high-risk precancerous lesions or have had cervical cancer in the past
Why did the USPSTF make these recommendations?
Anyone under 30 who is sexually active will likely develop an HPV infection. This is a very common infection in this age group (affecting up to 80 percent), and these infections almost always clear up on their own in one to two years without causing cancer in a normally healthy individual. If you took cervical samples from this age group, you would likely see abnormal cells due to the HPV infection. It’s difficult not to “do” something when you hear the words abnormal or precancerous, so doctors and patients may opt for more testing or invasive treatments. This all may cause increased psychological stress and the tests and treatments could possibly harm future fertility and pregnancy. And, since it may take 10 years for HPV to progress to cancer, annual testing may cause more harm than prevention. So testing every three years in this group is often enough, but is definitely not necessary every year.
These recommendations also give an endpoint to testing for those who are older and have low risk. The USPSTF says this “applies to all women who have a cervix, regardless of sexual history.” There are some people, such as HIV-positive women, who may not fall under these new recommendations, and they need to discuss this with a doctor.
And, if you had the HPV vaccine, remember that you still need Pap testing, because the vaccine does not protect against all HPV types.
But don’t stop going to your annual reproductive exam. It is so much more than a Pap test — you can have a physical exam, get STD testing, discuss your overall health, and get prescriptions for birth control (which Planned Parenthood offers without mandatory pelvic exams). You can make an appointment at a Planned Parenthood health center to discuss Pap testing, annual reproductive exams, and other health care options with a clinician.