The New HPV Test You Should Ask Your Doctor About
Why improve on the Pap?
This one test has made a huge difference in the health of American women; since the Pap's introduction in the 1940s, cervical cancer rates have been slashed by 70 percent, to 11,270 cases and 4,070 deaths in 2009. But the test has problems. For one, a single Pap can miss up to 50 percent of cell abnormalities (but because these changes usually occur very slowly, chances are great that an abnormality will be picked up on your next test). The Pap can also raise a false alarm when nothing's really wrong: Cervical tissue undergoes surface changes all the time, and these may pop up on your Pap, then disappear on their own. No screen can ever be considered 100 percent perfect, but the Pap/HPV combo comes pretty close. Studies from the U.S. and Europe show if you have negative results on the two tests given together, you can be 99.84 percent assured you won't develop cervical cancer within the next three or more years, says Alan G. Waxman, M.D., M.P.H., professor of obstetrics and gynecology at the University of New Mexico School of Medicine and lead author of the cervical-screening guidelines published by ACOG last December.
Do you still need an annual Pap test?
Actually, since 1987, virtually every medical organization that has issued guidelines on cervical screening has endorsed the idea that after three successive "normals," a healthy, low-risk woman age 30 or over needs to be tested only every two to three years. "The tradition of annual Pap tests is just that, a tradition, and it's not backed up by science," says Debbie Saslow, Ph.D., the American Cancer Society's director of breast and gynecologic cancers. Only women considered at high risk — DES daughters, for example, or those who've had cervical cancer or precancerous lesions — need more frequent tests. (Smoking also ups your risk; if you smoke, ask about extra tests.) Even if you don't have a Pap, though, you should have regular checkups that include breast and pelvic exams, a blood pressure reading, and other tests depending on your age and medical history.
OK, but what if a yearly Pap makes you feel safer?
Trouble is, each time you're tested, you run the risk of an abnormal finding. And though there's a strong chance that any aberrant cells would be cleared by your body before your next test two or three years later, now the doctor has to "do something," which might include removing those cells. You're subject to needless procedures, not to mention a lot of anxiety about the possibility of cancer — all for a disease that likely would never have developed.
If you have an HPV test and a Pap and both are normal, what next?
You're "free," so to speak, for three years. "Even if a 40-something woman went out and got a new infection the very next day, she would be effectively setting the clock back to zero; her risk of cervical cancer wouldn't rise significantly until she was in her 60s," says Mark Schiffman, M.P.H., M.D., senior investigator at the National Cancer Institute. In other words, a double "all-clear" may finally give a woman — and her doctor — the peace of mind to break the Pap-every-year habit.