HPV Test May Replace Pap for Some Women, New Guidelines Say
The Pap smear has long been the gold standard for cervical cancer screening, but an expert panel now says the HPV (human papillomavirus) test is also an option for women over 30.
These women now have three choices under new recommendations issued by the U.S. Preventive Services Task Force (USPSTF):
- A Pap test screening every three years.
- An HPV test alone every five years -- HPV is a virus known to cause cervical cancer.
- Both tests every five years.
The task force also recommended a Pap test alone every three years for women between the ages of 21 and 29.
"It's very important for all women to get screened for cervical cancer. Screening can reduce deaths from cervical cancer," said Dr. Douglas Owens, vice chair of the USPSTF.
"There are three good options for screening for cervical cancer in women 30 to 65. Our recommendation is that women have a conversation with their clinician about which option is best for them," Owens added.
A Pap test looks for changes in cells from the cervix that indicate cancer or precancerous changes, according to the U.S. Office on Women's Health. The HPV test looks for evidence of the virus in cells, but not for cancerous changes, according to the American Cancer Society (ACS).
Almost all cases of cervical cancer are caused by high-risk HPV infections, according to background information in the recommendations. Both tests use samples collected from a woman's cervix. A woman won't be able to tell a difference in the tests, the ACS said.
The task force didn't recommend HPV testing or co-testing for younger women.
Debbie Saslow, senior director of HPV-related and women's cancers for the ACS, explained why it's not a good idea to test for HPV in women under 30. "Almost everybody gets HPV, but more than 99 percent of the time, HPV goes away on its own. If you test for HPV in younger women [before the infection has a chance to clear on its own], it would be unnecessarily alarming," she said.
Dr. George Sawaya, author of an editorial accompanying the new recommendations, agreed.
"HPV testing sooner [than age 30] will lead to more 'false alarms,'" he said. "In other words, some women will have invasive diagnostic procedures and be found to have no cervical problem." Sawaya is a professor of obstetrics and gynecology at the University of California, San Francisco.
The task force also made recommendations about who doesn't need cervical cancer screening. This included women under 21, women who've had a hysterectomy that included removal of the cervix, women aged 65 and older who have had adequate screening in the past and aren't at a high risk of HPV.
Saslow said the most important message women need to take away from the new recommendations is simple: get screened.
"Most cervical cancer is in women who don't ever get screened or who get screened rarely. Whatever test is available to you, get screened. If you have a choice, and you're over 30, ask for an HPV test," she suggested.
Sawaya concurred. "Regardless of the method used for screening, the most important thing for women is to have easy access to affordable screening," he said.
Saslow also pointed out that young people should be sure to get the HPV vaccine if they didn't get it in their pre-teen years. Men and women can get the HPV vaccine up until age 26, though younger is better, she added.
The new recommendations were published in the Aug. 21 issue of the Journal of the American Medical Association.
Learn more about cervical cancer prevention and screening from the American Cancer Society.
SOURCES: Douglas Owens, M.D., vice chair, U.S. Preventive Services Task Force, professor, medicine, Stanford University, and physician, VA Palo Alto Health System, California; Debbie Saslow, Ph.D., senior director, HPV-related and women's cancers, American Cancer Society; George Sawaya, M.D., professor, obstetrics and gynecology, and reproductive sciences, epidemiology and biostatistics, University of California, San Francisco; Aug. 21, 2018, Journal of the American Medical Association