Is Pap Testing Better Than HPV Vaccination?

Good news: The decision to be vaccinated for HPV or receive regular Pap testing isn't either/or. Image: Andy Newson

Good news: The decision to be vaccinated for HPV or receive regular Pap testing isn’t either/or. Image: Andy Newson

It’s January, which means that it’s Cervical Health Awareness Month! If you have a cervix, there are two big things you can do to protect its health: get vaccinated against human papillomavirus (HPV) before becoming sexually active, and receive regular Pap testing after becoming sexually active. When you take both of these steps, you can maximize what modern medicine has to offer. However, some people think you can just do one and ignore the other. Are they right?

You’ve probably heard of HPV, which causes genital warts and certain cancers. This virus has the dubious honor of being the most common sexually transmitted pathogen — some call it “the common cold of STDs.” According to the Centers for Disease Control and Prevention, “HPV is so common that nearly all sexually-active men and women get it at some point in their lives. This is true even for people who only have sex with one person in their lifetime.”

HPV isn’t just the “cervical cancer virus” — it’s a jack of all trades that can trigger cellular abnormalities all over the body.

One of the cancers most commonly caused by HPV is cervical cancer. In fact, when Gardasil, the most popular HPV vaccine in the United States, made its debut, it was marketed as a “cervical cancer vaccine,” despite the fact that HPV can cause other types of cancer. Nevertheless, a vaccine that could protect against such a common and potentially dangerous virus was good news indeed. However, some critics were quick to point out that cervical cancer is rare in the United States, thanks to widespread access to Pap testing, an effective screening procedure that can catch cellular abnormalities when they are still in their “precancerous” stages, allowing them to be treated before progressing to cancer.

For those of us planning to receive regular Pap testing, is vaccination really necessary? Likewise, if we’ve been vaccinated against HPV, do we really need regular Pap tests? Let’s examine both questions separately.

Can I skip Pap testing if I’ve been vaccinated with Gardasil?

There are many strains of HPV, and “high-risk” strains can cause cervical cancer. Luckily, Gardasil protects against HPV-16 and HPV-18, two high-risk strains that cause 70 percent of cervical cancers. Unfortunately, there are other strains of HPV out there that can cause cancer, and even though they’re not as common as the strains that Gardasil protects against, a fully vaccinated, sexually active person is still susceptible to them. While future HPV vaccines will offer protection against more viral strains, the recommendation for regular Pap testing doesn’t appear to be in danger of extinction any time soon.

Pap tests are still recommended to screen for cervical cancers and “precancers,” even in people who have received the HPV vaccine, because it’s possible to be infected with some of the less common HPV strains. The good news is that Gardasil decreases your risk of most HPV infections, so even though you’ll still be encouraged to receive regular Pap testing, your chances of developing “precancer” will be lower.

If I get regular Pap tests, why should I be vaccinated with Gardasil?

Last month, a guest on Katie Couric’s daytime talk show claimed that HPV vaccination is unnecessary, because cervical cancer can be prevented by regular Pap testing. It’s true that cervical cancer rates have plummeted in countries whose inhabitants have widespread access to Pap testing, and that people who regularly receive Pap tests are much less likely to wind up with cervical cancer. Does this mean the vaccine is unnecessary? Hardly.

In Australia, where vaccination rates are much higher than in the United States, genital wart rates fell by 93 percent in females less than 21 years of age — all thanks to a successful vaccination program. Australians are also seeing declines in “precancer” and a decrease in HPV infections. Even in the United States, where the vaccination rate is comparatively low, recent studies have shown declines in high-risk HPV infections and genital wart incidence among teenage girls, though not as dramatic as those seen in Australia.

What does this mean? It means that being vaccinated against HPV makes you less likely to develop an HPV infection in the first place — which in turn makes you less likely to have warts or an abnormal Pap test result. If you don’t have genital warts, you don’t need to pay a dermatologist to remove them. And if you don’t receive an abnormal Pap test result, you don’t have to subject yourself to invasive, possibly painful or uncomfortable, followup procedures, such as colposcopy. That alone could make Gardasil worth the price of admission.

There are a few more reasons to consider vaccination: anal cancer, oral cancer, and genital warts. The Pap test only screens for cervical cancer, whereas HPV can cause cancers in areas other than the cervix, including the anus (engaging in receptive anal sex increases risk) and the oral cavity (performing oral sex, especially contact with female genitals, increases risk). Anal and oral cancers can strike anyone, regardless of gender, and all sexually active people are at risk for genital warts (additionally, HPV can cause penile cancers in males). Pap testing doesn’t address any of these possibilities, because HPV isn’t just the “cervical cancer virus” — it’s a jack of all trades that can kick off cellular abnormalities in many anatomical regions.

You can visit a Planned Parenthood health center to receive a Pap test, Gardasil shots — or both! While Gardasil is recommended before becoming sexually active, you can still receive it if you’ve already had sex. If you have any questions, you can make an appointment to talk to one of our sexual health experts!