Pap or HPV Test or Both?

Micrograph of an adenosquamous carcinoma. Uter...

Cervical cancer up close

I just finished writing an article about cervical cancer for my on line column on women’s health in Maine Women Magazine. While doing the research, I discovered that a lot of women are confused about what tests they should have and how often. Many also don’t have the latest information on the primary cause of cervical cancer.  I decided it was important to share what I learned with as many people as possible.

Recommended cervical cancer screening tests

  • 1st Pap test at age 21, whether or not you’ve been sexually active
  • 21-65 Pap test every three years
  • 30 and older also do HPV test every five years
  • 65 and older may discontinue if three or more negative tests in a row and no abnormal test results in past 10 years

In the past 50 years, the Pap test has saved countless lives because it detects microscopic abnormal cells that could be signs of cervical cancer. It’s still an important test, but health experts now say that as a routine, women don’t need one every year. And, an HPV test, which can be done at the same time as the Pap, is recommended for women over 30.

HPV (human papillomavirus) supposedly causes nearly 100% of all cervical cancers. It’s a common virus with more than 100 strains, most harmless. However, 15 strains have been linked to a variety of cancers — of the cervix, anus, vulva, vagina, penis and throat.

About 40, according to the National Cancer Institute, can be sexually transmitted. You don’t need to exchange any bodily fluids to be exposed, it takes only intimate skin to skin contact. Most of the time a sexually transmitted HPV infection doesn’t cause a problem. Some strains will cause genital warts, which can be treated, but you could have an infection and never even know it because your immune system clears it away with no further problems. The risk is that in a small percentage of women with a particular strain of HPV, the infection persists, putting them at risk of developing cancer of the cervix.

Because there is such a high rate of HPV infections in women under 30 and most of the time they simply go away, HPV testing is not recommended as a screening tool in that age group. Also, cervical cancer is slow growing and tends to be rare under 30, so health experts say it’s fine to get a Pap every two years.

After 30 the rate of HPV infection decreases and screening results are more meaningful, so testing is recommended at the same time you get your Pap test.  Again, even if you find out you have an infection, most of the time your immune system will get rid of it. However, in a small group of women, the infection doesn’t go away and may cause normal cells to change and eventually become cancerous.

According to a National Cancer Institute study that involved more than 300, 000 women 30 and older, screening every three years after age 30 is still acceptable, and adding the HPV test is important because it can predict who may be at high risk of developing cervical cancer in the future.

The average age of women who are diagnosed with cervical cancer is 54, but precancerous cells usually show up in much younger women. It is usually take years for them to develop into cancer. Screening is so important because it can pick up those earlier cells before they become cancerous. Yet women still put it off.  I talked with Dr. Michael Jones Chief of Pathology at Maine Medical Center, who told me that unfortunately, they still see younger women who have fallen through the cracks. But mostly they diagnose cervical cancer in older women, many of whom stopped getting regular check ups when they stopped having babies. If money is an issue, the Maine Breast and Cervical Health Program provides Pap tests and mammograms for eligible women. If you don’t really have a good excuse, please drop what you’re doing and make an appointment immediately!

I’m pushy because I care.

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