Pap smears have been used worldwide as a clinical tool for the early detection of cervical cancer for more than 80 years, but times are changing, and current guidelines say women can get a human papillomavirus (HPV) test instead, which causes less discomfort than a Pap smear.
Dr. Kelly Kennedy, a gynecologist with Orlando Health Medical Group in Vero Beach, says most of her patients still request a Pap smear but more and more are asking questions about the HPV test.
Dr. Kennedy finds value in both tests. “There are pros and cons for each. The HPV testing is more black-and-white, which is helpful in situations where there might not be a good pathologist to determine a cellular diagnosis.
“But there are still benefits to the Pap smear,” she adds. “It can detect low- or high-grade levels of change to cells. Low-grade means there are mild changes to the cells, and high-grade changes indicate moderate to severe changes. These results help us determine if further testing is needed.”
What’s the difference between the two tests? According to Scripps Health, a Pap test checks for abnormal cells in the cervix that could lead to cervical cancer if left untreated. HPV screening checks for high-risk types of HPV that can cause pre-cancers of the cervix, which is part of a woman’s reproductive system.
The HPV test offers less pain and more convenience, according to Dr. Kennedy.
“For the Pap, a brush is used to collect the cells, which are then sent to the pathologist to be evaluated under microscope” he said. “This can be uncomfortable but generally not painful. Those who are more sensitive to the exam can opt to just do the HPV test, which is a Q-tip-like swab of the cervix.
“There are also home tests to detect HPV,” she says, “although some people are not necessarily comfortable using them.” The home-testing kits are not yet FDA approved.
In addition to screening for cancer, Pap tests can provide other important medical information.
Dr. Kennedy says, “Results can reveal other things that can cause cells to look abnormal, including irritation, some infections (such as a yeast infection), growths (such as polyps in the uterus), and changes in hormones that occur during pregnancy or menopause. Although these things may make cervical cells look abnormal, they are not related to cancer.”
Dr. Kennedy finds that some labs aren’t familiar with HPV tests yet. “HPV is a newer test and there are labs that aren’t set up for the testing. HPV-only testing has not been universally adopted, and it does take time for the testing sites to be in sync with the guidelines.”
According to the University of Kansas Cancer Center, death from cervical cancer is nearly 100 percent preventable with routine cervical cancer screening. And the National Cancer Institute states that when cervical cancer is diagnosed at an early stage, the five-year survival rate is very high.
The Centers for Disease Control has lowered the recommended age for starting cervical cancer testing from 25 to 21.
The American College of Obstetricians and Gynecologists offers guidance on frequency of testing. Women should still visit their OB-GYN each year, but the group no longer advises women to have an annual Pap test.
The reason for the change? A better understanding of the way cervical cancer grows. Because it takes many years to develop, the time between screenings has been expanded. Plus having two tests in the doctor’s toolkit gives more information to work with.
Their recommendations are:
- Women aged 21-29 should have a Pap test alone every three years. HPV testing alone can be considered for women who are 25-29, but Pap tests are preferred.
- Women aged 30-65 have three options for testing. They can have both a Pap test and an HPV test every five years. They can have a Pap test alone every three years. Or they can have HPV testing alone every five years.
- After age 65, you can stop having cervical cancer screenings if you have never had abnormal cervical cells or cervical cancer, and you’ve had two or three negative screening tests in a row, depending on the type of test.
While Pap smears may be fading, cervical cancer screening is more important than ever. HPV testing may soon replace Pap smears altogether, but for now, you can choose the test you prefer. You can ask your healthcare provider what options they offer and work with them to create a cervical cancer prevention plan that works for you.
Dr. Kelly Kennedy, MB, Bch, BAO, LRCP&SI, is a gynecologist with Orlando Health Medical Group (OHMG). She is board certified by American Board of Obstetrics and Gynecology. OHMG is located at 3745 11th Circle, Suite 101, Vero Beach. Call 772-567-6412 to make an appointment.
