Once upon a time, cervical cancer screening took place during the annual Pap smear. But the once-annual Pap eventually became the every-three-years Pap, and now some women won't need to get it at all—they'll be able to get testing for the human papilloma virus (HPV) instead.
This week, the U.S. Preventive Services Task Force (USPSTF) released a new recommendation that gives many women a new option—one that doesn't include the Pap at all.
According to the new recommendation, women between the ages of 30 and 65 can choose to get a test for HPV every five years, a Pap test every three years, or a combo of both every five years. For women who are 21 to 29, the USPSTF recommends screening for cervical cancer every three years with a Pap test.
If this all sounds oddly familiar, it's because these guidelines have changed a few times in the past several years. Under the previous guidelines, it was recommended that women ages 21 to 29 get a Pap test every three years, while women ages 30 to 65 could get either the Pap test every three years or a Pap test and HPV test together every five years. The only difference now is that women ages 30 and older can choose to get the HPV test alone every five years.
Cervical cancer is relatively rare—it's estimated that there will be about 13,200 new cases in the U.S. this year—but it's also deadly, especially among women of color. And nearly all cases of cervical cancer are caused by an HPV infection. So, looking for the virus makes sense. But this is the first time a major organization has given people the option of screening only for the virus without the classic Pap test.
The Pap looks for changes in your cervical cells that can lead to cancer, but the HPV test looks for strains of the virus that can cause those cellular changes.
The HPV test is useful because some strains of the virus can cause cellular changes on the cervix that may eventually lead to cancer, according to the Centers for Disease Control and Prevention (CDC). So, why aren't we always testing for it? Well, HPV is the most common sexually transmitted infection in the U.S. and many people are able to clear it without treatment or symptoms. That's why routine HPV screening isn't recommended for people under the age of 30.
It's also important to note that this HPV test being recommended to women 30 years and older only looks for the few strains of the virus associated with cervical cancer, Carol Mangione, M.D., a USPSTF member who worked on the recommendation, explains to SELF. That means that, even if your HPV test is negative, that doesn't automatically mean you don't have or have never had HPV, Lauren Streicher, M.D., a professor of clinical obstetrics and gynecology at Northwestern University Feinberg School of Medicine, tells SELF. But it does mean you don’t currently have a strain of HPV that could cause cancer.
If you’re at low risk for cervical cancer—meaning you don’t smoke, don’t have a weakened immune system, haven’t had three or more children, and haven’t recently had an abnormal Pap or positive HPV test—it doesn’t really matter which test you go with, provided you follow the guidelines, Dr. Streicher says.
So, if you fall into this group, you can talk to your doctor about going for the HPV test without a Pap. But, know that they take about the same amount of time and feel about the same. (Yes, the HPV test still involves a speculum.) However, if you've recently had an abnormal pap smear or positive HPV test, your doctor may recommend a different screening frequency.
The HPV test has a higher rate of false positives, but you don't have to do it as often as the Pap.
As SELF reported previously, the HPV test is more likely to give you a false positive than the Pap, meaning you're more likely to get an abnormal result that turns out to be nothing after further testing. That's partly because you can have a strain of HPV that causes cervical cancer that your body clears on its own. It turns out that your body actually does a really good job of clearing out abnormal cells.
That's one reason why the USPSTF is recommending that HPV testing happens less frequently than Pap testing. Previously, women might have been subjected to additional testing like biopsies that come with their own set of risks and complications when their bodies may have simply cleared the virus on its own with time, Dr. Mangione says. This is also why routine HPV testing isn’t recommended for women under the age of 30, Dr. Mangione says, when the immune system is better at clearing those infections before they become problematic.
The good news is that if you have an HPV infection that your body wipes out, any precancerous changes that might have developed on your cervix usually go back to normal, Jason Wright, M.D., chief of gynecologic oncology, NewYork-Presbyterian/Columbia University Irving Medical Center, tells SELF. “Women usually only develop cervical cancer if the virus persists in the cervix,” he adds.
Whichever test you choose, it's most important that you get screened at regular intervals (whatever that means for your situation).
Your choice of test really comes down to your personal preference, your individual risk factors, and the options that your doctor offers, Dr. Mangione says. Some doctors may only have co-testing kits available, while others may only carry HPV or Pap tests, she says. Overall, the goal of the new recommendations is to give people more options so they can find something that works for them—and just get their freakin' screening done already.
So, if you're curious about which one is right for you, talk to your provider. After all, you should still see your ob/gyn every year even if you're not getting cervical cancer screening, which would be a perfect time to ask about your choices.