Q: How often should I get a Pap test and HPV screening?
A: A Pap test and HPV screening are two tools used in the detection of cervical cancer. A Pap test looks for precancerous changes in the cervix that could become cervical cancer if not treated appropriately. An HPV test looks for the human papillomavirus, which can cause these changes.
New guidelines suggest that low-risk women ages 21-29 have a Pap test done every three years and that there's no need for HPV screening unless there's an abnormal result on the Pap test. The reason for this recommendation is that most women under age 30 clear the HPV virus if it is present. Beginning at age 30, the preferred way to screen is with a Pap test combined with an HPV test every five years. This is called co-testing and should continue until age 65. An alternative regimen is a Pap smear or HPV testing every three years. Women who have received the HPV vaccine should also follow these guidelines since the HPV vaccine does not cover all strains of the virus.
Women who are at a high risk of cervical cancer because of a suppressed immune system or other factors may need to be screened more often and should discuss their screening interval with their doctor.
Under the new guidelines, women under the age of 21 should not be screened, regardless of sexual activity or other risk factors. This is because in this age group, most HPV infection as well as precancerous lesions clear spontaneously. Screening leads to overtreatment. The guidelines also state that women of any age who are low risk should not be screened every year by any screening method.
Women over the age of 65 who have had regular screenings in the previous 10 years with no abnormal results can stop screenings. Keep in mind that occasionally an endometrial cancer is found from a Pap smear. Also, while the incidence of cervical cancer declines with age, it does not go to zero. Women who have had a total hysterectomy can stop Pap tests and HPV screenings if the reason for the hysterectomy was not for cancer or precancer of the cervix.
These guidelines are different than what many of us are used to, so if you're unclear about them, please talk with your doctor. Any question is valid when it comes to your health and preventing cervical cancer. The decision of if and when to stop screening should be between the woman and her doctor.
These guidelines do not preclude the recommendation of an annual well-woman exam, which detects many other conditions that may affect a woman's health and well-being.
- Phyllis Miller, M.D., Erlanger Women's Institute for Specialized Health; Chattanooga-Hamilton County Medical Society member