Medical guidelines can be confusing for women keeping up with what they should be tested for, when and how often. It gets even more confusing when those guidelines change, which is the case with Pap smears and co-testing for HPV (human papillomavirus) for women over age 30. But these changes are a good thing because it means we’re making progress.
Pap smears test for changes in cells in the cervix that can indicate cervical cancer and for abnormal cells and infections that can lead to cancer. HPV testing checks for presence of that viral infection (there are more than 100 types), which can be of the low-risk variety that may only cause genital warts or of the high-risk variety that can lead to cervical and other types of cancer.
We used to recommend a Pap every year. When HPV co-testing became available several years ago, we recommended a co-test every three years. Now the new Pap guidelines suggest that if you are more than 30 years old and don’t have a strong history of abnormal Pap smears or cervical cancer, you can get a Pap with HPV testing every five years.
The reason behind this change in frequency is that if you co-test the Pap smear with HPV testing and they are both negative, your risk of cervical cancer in the next five years approaches 0 percent.
This five-year interval for those over age 30, however, is not for women who are:
- Immunocompromised (immune system not functioning properly)
- Have a personal history of abnormal Pap smears
- Have a personal history of HPV or cervical cancer
- Have a history of exposure to DES (Diethylstilbestrol: a drug that used to given to pregnant women).
For women who do not fit the new guidelines, it is recommended that you have exams more frequently than every five years. Depending on your specific situation your doctor will provide you with an appropriate exam schedule to follow. And women age 21-30 should continue to get a Pap smear every other year.
If you’re 30 or older and comfortable getting a Pap every five years, then this new guideline is for you. But if you will want another Pap in a year, it is not a good idea to do the co-test with HPV because that test is more expensive.
Be aware that sometimes this test will catch a positive HPV in women who have had all normal Pap smears previously. You should not panic about that. HPV is usually transient. It’s very common—60 percent of us get it in our lifetime if we are sexually active. It doesn’t mean you are going to get cancer. It just means you should not opt for the every-five-years screening.
Some women age 30 or older think that if they do the co-test for Pap and HPV once every five years then they don’t have to have a gynecological exam every year. But that is not the case.
You should always have a pelvic exam and a breast exam with your physician every year regardless if you are not doing a Pap smear. That exam is very important because it picks up things like fibroids, ovarian masses, pelvic pains, contraception issues, problems with abnormal bleeding, and all the other things we look for in an annual exam. Normally the only screening we do at an annual exam is for cervical cancer.