Over the last several decades, women and their doctors have come to rely on the Pap smear for cervical cancer screening. But today, the U.S. Preventive Services Task Force (USPSTF) released a new proposed recommendation, which would give women a choice between two different tests—including one that only has to be performed every five years.
Currently, the USPSTF recommends a Pap smear every three years for women ages 21 to 65—and that part of the recommendation is staying the same. But they also currently give women ages 30-65 the option to either get a Pap every three years or get a Pap test and HPV test together every five years.
The change, Carol Mangione, M.D., member of the USPSTF, tells SELF, was driven by recent research suggesting that doing both tests at the same time leads to more unnecessary follow-up testing than doing either test on its own.
“Unnecessary testing in good hands is usually quite safe,” Dr. Mangione says. But for a small percentage of women, undergoing cervical procedures leads to scarring or other abnormalities that can make it hard to carry a pregnancy in the future. So the goal is to reduce the unnecessary testing (and the accompanying anxiety) without missing any cancers; giving women a choice between these two procedures rather than recommending that all women get both may be one way to do that.
Because this is just a draft recommendation, organizations, researchers, doctors, and the public are encouraged to give their comments on the proposed changes until October 9th.
If approved, “this would be a fairly major change to cancer screening,” Jason D. Wright, M.D., Chief of the Division of Gynecologic Oncology at NewYork-Presbyterian/Columbia University Medical Center, tells SELF. “This is pretty different than the current recommendations, which in general call for co-testing [with both Pap and HPV tests].” Although there’s been mounting evidence over the past few years that the HPV test is effective on its own as a method for cervical cancer screening, this is the first time that using it in this way has been actually recommended, he says.
During a Pap smear (which is just one form of cervical cytology), “actual cells are gently scraped off the surface of the cervix and are looked at for any evidence of an abnormality that might suggest cervical cancer,” Dr. Mangione explains. But the HPV test isn’t looking directly at the cells, it’s looking for evidence that the virus is on those cervical cells. “It’s a test for an infection,” she says. And it’s an infection that’s responsible for over 99 percent of cervical cancer cases, Dr. Wright says.
So, looking for the presence of the infection is still a good way to screen for the early stages of cervical cancer. The only reason this test isn’t recommended for people under 30 is that younger people have beefier immune systems and, therefore, are more likely to clear HPV infections before they cause any worrying changes to cervical cells. “We wouldn’t want to do a biopsy or additional testing if it was an infection that was going to go away on its own,” she says. Plus, if they’re following the USPSTF guidelines, those patients will already be getting a Pap every three years anyway.
For the most part, both tests seem to be highly effective at screening for cervical cancer. However, Dr. Wright says, the HPV test has a higher rate of false-positives than cervical cytology, meaning that patients who choose that test are slightly more likely to have abnormal results that turn out to be totally fine after subsequent testing. On the other hand, the rate of cancer detection is a little bit lower with the Pap than with the HPV test, he says.
Choosing which test is right for you is a discussion you’ll need to have with your doctor, Dr. Mangione says. The two tests feel similarly and take about the same amount of time, but occur at different intervals. Maybe you’d just rather not have either test for five years because it’s a pain to get out to your gyno’s office and you’ll take your chances with false positives. Or perhaps you’d rather be tested more frequently because it’ll put your mind at ease. Your specific health and lifestyle factors will likely play a role, too.
Keep in mind that if you have a history of abnormal Pap results, have a weakened immune system, or were exposed to diethylstilbestrol (DES) as a fetus, these recommendations won’t apply to you. Those factors put you at a higher risk for cervical cancer so you’ll have to be screened more frequently.
Rather than getting hung up on which test to choose, she says the most important thing is to just get one. Although cervical cancer is relatively rare, it is quite deadly—especially among women of color. “All of these modalities are very good at detecting high grade precancerous changes,” Dr. Wright says. “Most women who develop cervical cancer didn’t have any screening performed.”
And remember: Just because you don’t need a Pap smear every year doesn’t mean you can skip your annual gyno appointment.
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