September 20, 2018
Can Women Skip the Pap Test?

Can Women Skip the Pap Test?

by Berkeley Wellness  

In September 2017, the influential U.S. Pre­ventive Services Task Force (USPSTF) released updated draft guidelines about screening for cervical cancer. In the period of public comments that followed, it undoubt­edly got an earful from other health orga­nizations, as well as some women’s groups, who either question the proposed changes or outright oppose them. That’s because the changes suggest that women 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 draft 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 either a Pap test every three years or an HPV test 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.

The USPSTF previously advised a Pap test every three years or co-testing every five years with both HPV and Pap (using cervi­cal cells collected at the same time), but not the HPV test alone. The new draft guide­lines state that “co-testing does not offer any benefit in terms of cancer reduction or life-years gained” over HPV testing alone.

Not the last word

Other expert groups—including the Amer­ican Cancer Society, American College of Obstetricians and Gynecologists, and American Society for Colposcopy and Cer­vical Pathology—agreed with the previous USPSTF guidelines and are sticking with them. That is, they are not including HPV testing as a stand-alone option, at least so far. This is hardly the first time that specialty organizations have disagreed with the USPSTF.

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.

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: As of January 2018, the USPSTF’s recommendations are only a draft. It may still decide to include co-testing as an option. Meanwhile, the debate about the best way to screen for cervical cancer shouldn’t put women off getting tested. 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.