December 11, 2018
Cervical Cancer Screening: Goodbye, Pap Test?

Cervical Cancer Screening: Goodbye, Pap Test?

by Berkeley Wellness

In August 2018, the influential U.S. Pre­ventive Services Task Force (USPSTF) released updated guidelines about screening for cervical cancer. The main change is that the USPSTF now says thatwomen can safely opt to skip the Pap test—one of the most effective cancer screening tools ever devised and a staple of women’s health checkups for generations—and get an HPV (human papillomavirus) test instead. Both tests analyze a sample of cells collected from the surface of the cervix, but while the Pap test looks for precancerous lesions, the HPV test detects “high-risk” types of the human papillomavirus that cause cervical cancer (as well as some other cancers).

The recommendations, based on a review of the latest research, say that average-risk women ages 30 to 65 can be screened for cervical cancer via any of three options:

  • A Pap test every three years
  • An HPV test every five years
  • Both tests (co-testing using cervical cells collected at the same time) every five years

The USPSTF concluded that both Pap alone and HPV testing alone “offer a reasonable balance between benefits and harms.” In a few developed countries (such as the Netherlands and Australia), as well as in parts of the developing world, HPV testing has already become the pri­mary way of screening for cervical cancer.

Cervical Cancer Symptoms

Cervical cancer typically has no symptoms in its early stages. Here's a list of symptoms that may appear as the disease progresses.

In its earlier draft guidelines, the USPSTF withdrew its prior recommendation about co-testing, stating that “co-testing does not offer any benefit in terms of cancer reduction or life-years gained” over HPV testing alone. But after reviewing public comments, it retained co-testing as an option.

Other expert groups—including the Amer­ican Cancer Society, American College of Obstetricians and Gynecologists, and American Society for Colposcopy and Cervical Pathology—are not including HPV testing as a stand-alone option, at least so far.

How should you be screened?

Women should talk with their doctors about which screening strategy is best for them—all have advantages and disadvantages. For instance, it’s estimated that HPV testing prevents slightly more cases of cancer than the Pap test (one extra cancer case per 1,000 women screened, according to the USPSTF), but it produces more false-positive results, leading to unnecessary follow-up procedures (colposcopy). Co-testing leads to even more false-positive results.

The USPSTF and other expert groups still agree that women should start Pap testing at age 21, then repeat it every three years until age 30. HPV testing is not rec­ommended for women in their twenties because they are more likely to have transient HPV infection, leading to very high rates of false-positive results.

Screening for Other Gynecological Cancers

No effective endometrial and ovarian cancer screening strategies exist for average-risk women without symptoms, making awareness of symptoms and early detection of both cancers particularly important.

All of the screening recommendations apply only to average-risk women. Women who have had a high-grade precancerous cervical lesion removed or who are otherwise at high risk need more frequent evaluation.

And women over 65 who have been adequately screened and had no abnormal results can stop getting tested, as can women who have had a total hysterectomy (provided they never had cervical cancer).

Bottom line: Whether you do Pap or HPV testing or both, the key is to get screened regularly, period. Screening for cervical cancer is a proven lifesaver.

Also see Screening for Cervical Cancer and The HPV Vaccine and Teens.

Originally published January 2018. Updated November 2018.