New pap test guidelines you need to know about

You may not know his name, but if you’re a woman, you’ve probably taken Georgios Papanicolaou’s test.

The Greek-born American doctor discovered in 1928 that cancers could be detected in cells swabbed from the cervix. The “Pap” later became a centerpiece of health care for women between the ages of 21 and 65, credited with reducing cervical cancer rates and mortality by 80 percent. The disease that once ranked as a major killer now ranks as America’s 14 ^th most common women’s cancer.

But don’t be surprised if your gynecologist or primary care physician skips this year’s Pap test in favor of a human papillomavirus (HPV) screening. Although HPV affects almost everyone at some point, and often goes away on its own, it’s also the cause of virtually all cervical cancers.

“Infection with HPV is sufficient for the development of cervical cancer,” says Paul Blumenthal, M.D., Stanford University Medical Center professor of obstetrics and gynecology. “If there’s no HPV present, there’s no cervical cancer.”

So, if the HPV test is necessary to scan for cervical cancer, does that remove Pap tests from the equation entirely?

Not so, says gynecologic oncologist Sarah Dilley, M.D., of Indianapolis. “It’s still important to have an internal exam, but the Pap test will probably become secondary to the HPV test.”

To make things fuzzier for patients, both screenings are done the same way. They just look for different things.

Here’s how to tell which test you need, and when, and what to expect from a screening.

What Has Changed?

Researchers now blame HPV variants for over 90 percent of cervical cancers (and genital warts). The vaccine Gardasil is recommended for everyone starting at about age 11 (before youngsters become sexually active), and is FDA-approved for people up to age 45. The shot provides immunity from several HPV types.

“There are more than 100 strains of HPV. Not all cause cancer, but the vaccination protects against the seven strains that cause more than 90 percent of HPV-related cervical cancer,” says Dr. Dilley.

Here’s the main difference: A Pap test can confirm if you’ve been exposed to HPV. The HPV screening, however, can identify if you’ve actually been infected by it.

“The HPV test lets you know if you’ve been exposed, and the Pap test determines whether the exposure has affected the cells and whether additional steps are needed,” says Dr. Dilley.

How Does the Testing Work?

Samples for both tests are taken during an internal gynecological exam. The clinician collects some cervical cells, places them in a solution, and creates a slide for a technician to analyze. The cells are deemed normal, suspicious, or abnormal for a Pap test, and either positive or negative for HPV.

“A suspicious Pap test can require a follow-up colposcopy to examine the cervix more closely,” says Dr. Dilley. That can sometimes also lead to a biopsy, where tissue is removed for further testing.

After a positive HPV screening, additional tests can reveal whether the virus still lurks in the cell or has traveled to a potentially dangerous area in the body.

“We’ve learned how to tell the difference between a simple HPV infection and instances where it’s gotten into the nucleus––a possible one-way street to dysplasia and cancer,” says Dr. Blumenthal.

Who Should Get Screened, and How Often?

The U.S. Preventive Services Task Force (USPSTF) recommends screening for cervical cancer (Pap test) every three years with cervical cytology alone in women aged 21 to 29 years. For females aged 30 and older, human papillomavirus (HPV) screening is recommended every three years. For those who want to lengthen the screening interval, screening with a combination of Pap test and HPV co-testing is recommended every five years for females aged 30-65. Cervical cancer screening is not recommended before age 21. Be sure to talk to your doctor about what type of screening is best for you.

HIV-positive women over 30 years old or those with compromised immunity may need more frequent testing but be sure to talk to your doctor first. Pap tests aren’t given to people under age 21, or to low-risk women over age 65 who’ve had normal Pap tests for a decade.

“If you’re HPV negative, you’re unlikely to have problems in the next few years,” explains Dr. Blumenthal. “But as we have more people now doing HPV testing in addition to, or as a precursor to, Pap, we can predict the future better than with Pap alone,” he says.

How Do I Prepare for a Pap test?

Doctors focus on what’s going on inside, not what’s happening outside, so ungroomed pubic hair, unshaven legs, and raggedy toenails won’t affect the exam—and probably won’t be noticed.

“Rather than physical preparation, women should think of questions they want to ask,” suggests Dr. Blumenthal. Have you noticed a particular symptom that’s bothering you, or has someone in your family been diagnosed with cervical cancer?

Try to skip activities that could alter vaginal flora. Avoid sex, douching (which doctors consider questionable anyway), and tampon use immediately before the exam. If possible, try to schedule testing after your period.

How Soon Do I Get My Results?

It can now take less time to get Pap test results than HPV results, but that varies in different locations and with different providers.

Once your results are in and there’s cause for concern from your doctor, you’ll be contacted for a follow-up appointment to repeat the test.

But don’t fret too much from an abnormal reading. “An abnormal Pap test or a positive HPV test doesn’t mean you have cancer,” says Dr. Blumenthal.

A mishandled slide or cervical inflammation (which usually does not have symptoms) may be to blame, and it can usually be corrected at the retest. And even if signs of precancer do exist, most cases are easily treated.

Can I Skip My Pap Test?

Even with the emergence of the HPV screening, you should probably still have a Pap test. According to the Centers for Disease Control and Prevention, approximately 50 to 64 percent of invasive cancer cases are diagnosed in women who have never been screened or have had screenings more than five years apart.

A lack of testing explains why the World Health Organization still ranks cervical cancer as a huge global public health problem. Roughly 570,000 new cases were reported in 2018, including some in low-income U.S. areas where women don’t know about, or can’t afford, screening.

What Else Might Be Changing Soon

While doctors determine the ideal balance between HPV and Pap tests, technological advances promise to make both tests more available and increasingly accurate.

“One of the next big things will involve machine learning or artificial intelligence to more thoroughly check for disease,” predicts Dr. Blumenthal.

Also on the horizon: at-home kits that will allow women to collect menstrual blood (where HPV can lurk) or vaginal tissue to send to a lab for processing.

“In the future, you may not need to go into the office for a cervical sample at all,” says Dr. Blumenthal. “You’ll perform the tests at home and come in for your visit already knowing the results.”

The ultimate goal, of course, is to combine the screening and the vaccine to achieve what was once unthinkable: the eradication of cervical cancer.

“Our children could possibly live in an entirely different world,” says Dr. Blumenthal.