DEAR MAYO CLINIC: I’m a 32-year-old woman, and I’ve always gotten a Pap test at the recommended time. Now my doctor suggests that I get an HPV test, too. Why would I need both? Won’t the Pap show if there are any problems?
ANSWER: This is a great question as this area generates a lot of confusion. A Pap test is an important screening exam that’s used to check for abnormal cells on the cervix that could indicate early-stage cervical cancer or precancerous cells. The test for human papillomavirus, or HPV, also is important because if you have that virus, it raises your risk for developing cervical cancer. Knowing if you have HPV or not can inform and direct your health care in the future.
Cervical cancer occurs in the cells of the cervix — the lower part of the uterus that connects to the vagina. Cervical cancer rarely causes symptoms in its early stages. The earlier it’s detected, however, the more likely it is that cervical cancer can be treated effectively. That’s why it’s so crucial to have cervical cancer screening with an HPV test, Pap test or both on a regular basis.
A Pap test is performed during an office visit with your health care provider and takes only a few minutes. It involves collecting and examining cells from the cervix. If the test finds abnormal cells, your health care provider will recommend additional tests to look further for precancerous or cancerous cells.
Along with a Pap test, HPV testing also provides useful information to your health care provider. An HPV test can be done at the same time as a Pap test and uses the same cell sample collected for the Pap test. The HPV test doesn’t tell you whether you have cancer. Instead, it detects the presence of HPV in your body. HPV is a common sexually transmitted infection, and it plays a role in causing almost all cervical cancer.
If you have HPV — particularly the types that are most closely linked to cervical cancer, such as types 16 and 18 — then you are at higher risk for developing cervical cancer. Knowing that, you and your health care provider can decide how often you need Pap tests and other tests to monitor your condition going forward.
The reason your health care provider hasn’t mentioned HPV testing to you before probably is due to your age and recent changes in screening recommendations. The HPV test in women under 30 has not been common in the U.S. and usually was not requested in young women unless there had been prior abnormal Pap tests. HPV spreads through sexual contact and is very common in young women. Because of that, HPV test results in that age group frequently are positive. However, HPV infections often clear on their own within a year or two, particularly in younger women. After that, they typically aren’t cause for concern.
Not all types of HPV increase the risk of cervical cancer. The HPV vaccine protects against the types of HPV that are most likely to cause cervical cancer. The vaccine works better when given to girls starting at age 9 but has now been approved for women through age 45.
In women older than 30, detecting a high-risk HPV infection poses greater risk. In that population, it’s more likely the infection has been in a woman’s system for a longer period of time, or it may have reactivated after an earlier infection. In either case, the likelihood that the virus could trigger cervical cell changes that lead to cancer is much higher than it is in younger women. Due to the higher risk of cervical cancer, more frequent testing is recommended in older women. It is important to note, though, that most women with a positive HPV test do not develop cervical cancer.
How often you need a Pap test and an HPV test depends on your individual situation. In general, the recommendation is to have both tests done every five years for women older than 30 who haven’t had an abnormal Pap test in the past. That may shift, however, depending on your medical history, as well as other health issues you may have. Talk with your health care provider about the schedule that’s best for you. — Dr. Margaret E. Long, Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota