Cervical Cancer Screening Updates: Pap Smear or HPV Test Only?

This year, nearly 13,000 women will be diagnosed with cervical cancer in the U.S. Luckily, advancements in screening for cervical cancer — which include the Pap smear and the HPV test — have helped the death rate from this condition fall by 50 percent over the last 40 years.

The guidelines for cervical cancer screening haven’t been updated since 2012, but a government panel recently issued recommendations that could change how and when women of a particular age are screened for the disease. Here’s what you should know.

Current Screening Guidelines

The American Cancer Society recommends women begin screening for cervical cancer at 21 years old. From ages 21 to 29, women should do a Pap test every three years. From ages 30 to 65, women should undergo co-testing — a method that combines a Pap test with an HPV test — every five years. Women in this age range also have the option of getting a Pap test alone every three years.

New Recommendations

In 2017, the U.S. Preventive Services Task Force (USPSTF), an independent panel made up of national health experts, issued recommendations that no longer favor co-testing in women age 30 to 65. Instead, USPSTF is recommending screening every three years with a Pap test alone or every five years with an HPV test alone.

Dr. Alison Vogell, a gynecologist at Lahey Hospital & Medical Center, believes the panel’s recommendation may be due to a growing body of research that indicates HPV testing is more effective for screening.

“The HPV test is a more accurate test,” said Vogell. “It’s more accurate in terms of its ability to predict the presence of precancerous or cancerous lesions, because of the higher false negative rate of [the Pap test].”

It’s important to note that these recommendations and the existing screening guidelines don’t apply to women who are at high risk, Vogell notes. This includes anyone who has a compromised immune system, those with HIV, women who have been exposed to the synthetic hormone diethylstilbestrol (DES) and anyone who is on chemotherapy or taking immunosuppressive medications. Women who have these risk factors should be screened more often based on the recommendation of their doctor.

How This Could Affect You

So, what do these draft recommendations mean for patients? First, it’s important to understand that the major gynecological health organizations, including The American Congress of Obstetricians and Gynecologists (ACOG) and The American Society for Colposcopy and Cervical Pathology (ASCCP), haven’t yet adopted these recommendations and still follow the 2012 screening guidelines, which advocate co-testing every five years. The ACOG even issued a statement saying it was reviewing the USPSTF draft recommendations and the supporting evidence to decide when (and if) it would update its own screening guidelines.

While we wait to see if these proposed recommendations are adopted by other health organizations, routine screening is still important. If you’re unclear about how often you should be screened, talk to your doctor.

“If a patient wants to discuss [doing only one test] or would like this as an alternative, that’s certainly something to discuss with your provider,” Vogell recommended. “You’re just talking about going from testing for HPV as well as cells, to doing HPV only testing. The important part of that is the HPV test, since it is more accurate in predicting a cervical lesion.”

*The content on this website is for informational purposes only and is not medical advice. Please consult a physician regarding your specific medical condition, diagnosis and/or treatment.

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