Guidelines for how to screen and when to screen for cervical cancer had been a moving target until late 2018, when the US Preventive Services Task Force clarified very simply what techniques work and how often screening needs to happen. But those guidelines are different depending on age. Here’s what you need to know…
FOR WOMEN AGES 30 TO 65
The guidelines state that you can choose between…
- Having the HPV (humanpapilloma virus) test every five years
- Having the Pap test every three years
- Co-testing with the Pap and HPV tests every five years
Why all the choices? Although research has shown that for women 30 years and older the HPV test picks up more suspect lesions sooner than the Pap test does and with fewer false positives, it will take time for the medical community to adopt such a landmark change (some doctors are still doing annual Pap tests even though the move to every three years is already over a decade old—know that since insurance reimbursement follows the current guidelines, patients may then be billed for screening too frequently). So, for the time being, the Pap is still one of the stand-alone options. It is also used after a stand-alone HPV test if that test comes back positive. The most expensive way to use the Pap test is to do it at the same time as the HPV test (co-testing)—it may provide a convenience but at a cost.
Discuss all three options with your doctor to find the most appropriate one for you. Your unique personal or family health history might lead your primary care physician to recommend one over another.
HOW HPV TESTING WORKS
Many experts believe that, ultimately, the HPV test will be the one standard. It looks for 14 high-risk strains of HPV including HPV-16 and HPV-18, the two responsible for 70% of all cervical cancers.
If you choose to have the HPV test and…
The test is negative, you won’t need any cervical cancer screening for five years.
The test is positive, it does not mean you have cancer, but does mean you’ll need to follow it up with a Pap test to give your doctor more information—whether the virus has caused any changes in your cervix or is just sitting there.
Your doctor may just be able to use the liquid from your HPV test to do the Pap test and not need to call you back for an exam.
What typically happens next…
- If that Pap test is normal or shows that any changes are minor, in a year you’ll repeat the HPV test to see if the virus cleared on its own and if not, have a repeat Pap to check for any further changes to the cervix.
- If the changes on your Pap are more severe, then you’ll likely have a colposcopy with biopsy. A colposcopy uses a lighted instrument to look for precancerous changes or lesions in the tissue of your cervix—a lesion is an indicator that there is usually more disease than is showing. Biopsies, or tissue samples, will be taken from both the outside and the inside of your cervix and examined.
- If all the results are negative, you’ll need to have two normal tests (a negative HPV and a normal Pap) six months after the biopsy and again six months later before you can return to every five-year screening.
- If the biopsies show severe changes, then you’ll have another procedure called LEEP, which uses electrical current to remove the abnormal cells from the cervix.
Note about the HPV test methods: Both the Pap and HPV tests can be done during a gynecological exam. However, you can also collect your own HPV sample at home with a swab and send it to a lab for testing.
Two recent studies looked at the effectiveness of self-collected HPV tests and found that the results were comparable to those done in a doctor’s office. These kits are already available online—examples include Selfcollect.com and Mylabbox.com and can be a good option for women without easy access to screening clinics.
FOR WOMEN AGES 21 TO 29
The guideline for this age group is for only the Pap test to be done every three years.
Why is there a difference based solely on age? Most sexually active young women have been exposed to at least one strain of HPV. The body will usually be able to rid itself of the virus on its own in two or three years. During that time, women will automatically test positive for HPV even though it’s unlikely that there’s any cancer. For those under 30, the Pap test is the more sensitive way to screen for cervical cancer.
FOR WOMEN OVER AGE 65
Although the guidelines don’t recommend screening for women in this age group who had adequate prior screening and are not at high risk, if you’re very sexually active—or your partners could be, talk to your doctor about continuing HPV screening.
FOR WOMEN WITH CERTAIN HEALTH CONDITIONS
All the above guidelines are for women at average risk of cervical cancer. They don’t address women who have a high risk for cervical cancer because of HIV-1, having had an organ transplant or their mothers took the drug DES to prevent miscarriage. If you’re in any of these situations, talk to your doctor about how often you should be screened and what tests are most appropriate.
Note: The BRCA gene is not associated with cervical cancer, so cervical cancer screening recommendations are independent of BRCA status.
TESTING FOR OTHER HPV-ASSOCIATED CANCERS
HPV is also associated with head and neck and anal cancers…and for women, vaginal and vulvar, and for men, penile cancers. There are no guidelines for routine screening for these cancers, but there are tests that can look for them. For instance, there’s an anal version of the Pap test that can look for precancerous changes…if you have itching or bleeding from your anus, talk to your doctor about this right away. The main warning sign for head and neck cancer is laryngitis that doesn’t seem to go away.
To understand more about the HPV infection, read “HPV: The Killer That We Don’t Talk Enough About.” And to help keep your immune system strong and able to clear the virus, practice these essentials: Eat a healthy diet…exercise regularly…drink alcohol in moderation…get appropriate screenings…and if you smoke, quit. Smoking makes your immune system less effective and speeds up the transition from healthy cells to cancerous ones.