If you have been to your gynecologist recently for your yearly exam you may have been surprised to find that you may not need a Pap for another 3-5 years. For decades women had scheduled their annual gynecological exams with the expectation of having a Pap smear performed. Weâ€™re not able to take the Pap smears to the next level. Cervical cancer screening today includes not only the Pap smear but human papilloma virus (HPV) testing. To understand why this was done and how it works itâ€™s best to get an understanding of the HPV virus.
In the 1980s, it was discovered that cervical cancer and the pre-cancerous cells that resulted in abnormal Pap smears, are due to a cervical infection from the Human papilloma virus (HPV). Further research was able to identify more that 100 HPV strains that can infect human epithelial cells. Approximately 40 of these viruses are specific to the tissue of the lower genital tract. This group can not be divided into both low risk and high risk types. It is this high risk group, consisting of 15 viruses, that is primarily responsible for cervical cancer and it’s precursors. It is for this reason that, after the age of 30, we not have the option to test specifically for these 15 high risk viruses. It is a combination of the information gathered from your Pap smear and the HPV result that helps physicians determine if an abnormality is present, if closer follow-up is needed, or if routine screening is sufficient.
Current guidelines recommend that all women without certain risk factors (i.e. HIV immunosuppression, DES exposure, prior precancerous cervical lesion or cervical cancer) between the age of 21 and 29 have a Pap test every 3 years. Women less than 21 years old no longer are required to have screening. Between the ages of 21 and 29, HPV co-testing is not recommended. Twenty percent of women in this age group have been found to carry the carcinogenic HPV types. Identifying these strains has lead to unnecessary testing and procedures, proven by the fact that most infections resolve spontaneously. (1) Women between the ages of 30 and 65 can be screened every 5 years with both. Pap smear and HPV co-testing, or every 3 years with Pap smear alone. Should any testing return abnormal your physician will discuss with you the next step in this evaluation.
American Society for Colposcopy and Cervical Pathology Screening Recommendations 2012
Andrea DiMichele, MD is an OB/GYN at Saltzer Medical Group. You can reach Dr. DiMichele at 463-3138