Let's face it: Most of us don't look forward to gynecologist appointments, but we do it because we like knowing all is well "down there."
While you should still schedule an annual visit with your health care professional, there's good news for those of us who don't look forward to the yearly Pap test, which checks for abnormal changes in cervical cells. Both the American Cancer Society (ACS) and the U.S. Preventive Services Task Force (USPSTF) have changed their screening guidelines, so most women can get the same reassurance with less frequent testing.
And there's additional good news: the current methods of screening for cervical cancer are more effective than ever. For women age 30 and older, the combination of a Pap test and the human papillomavirus (HPV) test is less likely to miss an abnormality than the Pap test alone.
Here are some important facts to know about HPV and screening for cervical cancer:
- Most women will be infected by HPV, a common skin cell virus, at some point in their lives.
- The virus is transmitted through skin-to-skin contact in the genital area, most often by sexual intercourse.
- Most HPV infections will go away on their own within two years.
- The HPV test looks to see if the types of the virus that can cause cervical cancer are present in the cells of the cervix.
- The Pap test looks at the cells for abnormal changes on the cervix caused by HPV.
- If certain types of HPV infect cervical cells for a prolonged period of time, there is a risk that the cells will change abnormally and may progress to cancer cells.
- Two types—HPV 16 and HPV 18—are responsible for 70 percent of all cervical cancer.
- If the HPV test is positive, it does not mean that a partner has been unfaithful. In fact, the reason women 30 and older, and not younger women, are tested for HPV is to find infections that have been present for a long time.
- If you have a high-risk type of HPV, your health care provider will monitor your cervical health as long as the virus remains in your cells.
- A woman could have HPV in her cervical cells for a long time and never develop a problem.
- If HPV is present, it can take as long as 10 to 15 years for cancer to develop.
The current cervical cancer screening guidelines, which were updated in March 2012, are as follows:
- Women younger than age 21 do not need Pap tests, because HPV infections and abnormal cell changes in the cervix in women younger than 21 will usually go away on their own.
- Women ages 21 to 29 should get a Pap test every three years. This replaces the previous guideline that women get tested annually. This is meant to increase benefits and reduce harm. When Pap tests are done annually, abnormal changes may be found that often go away on their own. If you have an abnormal Pap test result, you may be called in immediately for additional testing or for follow-up sooner than three years. HPV testing is not recommended for routine screening of women in this age group, because most women will have HPV in their 20s that will go away on its own.
- Women ages 30 to 65 now have the option of getting screened every five years with a combination of a Pap test and an HPV test, called co-testing. The American Cancer Society prefers this method for screening women 30 and older. Women ages 30 to 65 also have the option of continuing to be screened every 3 years with the Pap test alone.
- Women older than age 65 can stop getting cervical cancer screening if:
- they've had at least three normal Pap tests in a row; or
- they've had two normal results from two tests that combined the Pap test and HPV test over the past 10 years, with the most recent test having been within the past five years.
- Women who have had a hysterectomy and no longer have a cervix can stop getting cervical cancer screening if they do not have a history of precancer or cancer of the cervix.
Why the recent change in screening guidelines?
The ACS, USPSTF and ACOG regularly review scientific evidence about the benefits and harms of health screenings. They've found, in most cases, that cervical cancer is a slow-growing cancer, so testing for precancerous cervical changes more often than once every three to five years isn't necessary. Annual screening for cervical abnormalities yields only a very small increase in cancer prevention but leads to a large number of unnecessary procedures and treatments. Less frequent screening will increase benefits to women and decrease harm.
Also, by detecting the presence of high-risk types of HPV in the cells, the HPV test can help lead to looking for abnormalities and finding them at an earlier stage than would've been possible with the Pap test alone. Results from a recent large study done at Kaiser Permanente Northern California showed that in women age 30 or older, those who had both a normal Pap test and negative HPV test had virtually no risk for precancerous changes or cancers of the cervix for many years.
Based on this and other studies, researchers have found that when the Pap test is used together with the HPV test, a screening interval of once every five years gives health care professionals enough time to find and treat cervical abnormalities.
Combining the HPV test with the Pap test is more effective than the Pap test alone because the HPV test looks for DNA or RNA from high-risk types of HPV that may be staying in the cells of the cervix. This means that a woman who is at risk will be evaluated to see if her cervix is normal, even if her Pap test is negative. She will be followed more closely for as long as her HPV test remains positive. She may never develop precancer or cancer, but she will be carefully monitored.
It's important to note these changes to screening guidelines do not mean the end of your annual visit to the gynecologist—you should still go. But instead of spending time during your appointment on cervical cancer screening every year, you will have more time with your health care provider to discuss other important aspects of your health. Depending on your age, these conversations may involve family planning, menopause and the importance of a healthy diet.