{"id":17766,"date":"2018-09-28T13:13:37","date_gmt":"2018-09-28T18:13:37","guid":{"rendered":"http:\/\/thepapergown.zocdoc.com\/?p=17766"},"modified":"2023-03-22T14:24:48","modified_gmt":"2023-03-22T19:24:48","slug":"your-guide-to-pap-smears-and-hpv-testing","status":"publish","type":"post","link":"https:\/\/www.zocdoc.com\/blog\/guides\/your-guide-to-pap-smears-and-hpv-testing\/","title":{"rendered":"What to Know About Pap Smears and HPV Testing"},"content":{"rendered":"

For decades, Pap smears have been a critical health tool for people with uteruses.<\/span><\/p>\n

Pap smears, also known as Pap tests, are used to identify cancerous and precancerous cells in the cervix, <\/span>allowing doctors to detect cervical cancer in its early stages or before it has even developed<\/span><\/a>.<\/span><\/p>\n

Over the years, updates to Pap testing guidelines and a growing body of research on the human papillomavirus (HPV) \u2014 the leading cause of cervical cancer \u2014 have led to further strides in cervical cancer prevention. <\/span><\/p>\n

Before you book your next gynecologist appointment, it\u2019s important to know the differences been Pap and HPV testing, and to get acquainted with the latest guidelines for cervical cancer screening. These recommendations, which change as women age, were updated in 2018 to reflect new testing options for women over 30. <\/span><\/p>\n

We spoke with experts to find out what women need to know about cervical cancer screening and prevention today.<\/span><\/p>\n

The purpose of the Pap<\/h3>\n

The primary purpose of a Pap smear is to detect suspicious cells in the cervix that could indicate a risk of cancer. Terms like precancer, dysplasia and neoplasia are used interchangeably to refer to cells that are abnormal but are not cancer, according to <\/span>the National Cancer Institute<\/span><\/a>. <\/span><\/p>\n

For some women, a cervical cancer screening also includes HPV testing in addition to or in lieu of a Pap smear. With the help of Pap and HPV testing, cervical cancer is <\/span>one of the most preventable cancers.<\/span><\/a><\/p>\n

\u201cA Pap can sometimes help us find other conditions, like infections,\u201d says Dr. <\/span>Ana Cepin<\/span><\/a>, assistant professor of obstetrics and gynecology at Columbia University Medical Center and medical director of New York-Presbyterian\u2019s Family Planning Clinic. \u201cBut that\u2019s certainly not a primary reason why a woman should have a Pap smear done.\u201d<\/span><\/p>\n

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The link between HPV and cervical cancer<\/h3>\n

Nearly every case of cervical cancer is <\/span>caused by HPV<\/span><\/a>, but not all types of HPV lead to cancer. The vast majority of cervical cancer cases are <\/span>connected to only two strands of the virus<\/span><\/a>. <\/span><\/p>\n

HPV is also <\/span>the most common sexually transmitted infection<\/span><\/a>. \u201cAlmost everyone will have a transient HPV infection at some point in their lifetime,\u201d says Dr. <\/span>Lisa Barroilhet<\/span><\/a>, associate professor of gynecologic oncology at the University of Wisconsin. A transient infection is one that clears up on its own, usually within 12 months. <\/span><\/p>\n

Aside from cervical cancer, <\/span>HPV can also cause other cancers, including anal cancer, throat cancer and penile cancer.<\/span><\/a>\u00a0There are currently three FDA-approved vaccines<\/a> that protect against HPV infection. Every year in the U.S., HPV causes 33,700 cancers in men and women, but HPV vaccination can prevent more than 31,000 of the cancers from ever developing, according to the CDC<\/a>.\u00a0The CDC recommends that both boys and girls get the HPV vaccine during adolescence, ideally before sexual activity begins. <\/span>Until recently, HPV vaccination was only approved for people 26 and younger, but the FDA expanded approval<\/a> to men and women ages 27 to 45.\u00a0<\/span><\/p>\n

Although the HPV vaccine guards against some strains of the virus, it doesn\u2019t protect against all of them. That means that even if you\u2019ve been vaccinated, it\u2019s important to go in for regular cervical cancer screenings.<\/span><\/p>\n

What to expect in the exam room<\/h3>\n

Whether you\u2019re going in for a Pap smear, an HPV test or both, you can expect the same procedure at your doctor\u2019s office. <\/span><\/p>\n

The process can be a little uncomfortable, but it\u2019s quick and generally well-tolerated by patients, Cepin says. You\u2019ll lie on the exam table with your feet propped up in stirrups as your doctor inserts a speculum into your vagina, then uses a brush or spatula to collect cells from the cervix. You may feel some pressure from the speculum, but the procedure is usually over within a minute. After that, your doctor will send the cell sample to the lab for evaluation.<\/span><\/p>\n

What happens next at the lab depends on which test you\u2019re having done.<\/span><\/p>\n

For a Pap smear, cervical cells are smeared on a slide and examined under a microscope. A pathologist then subjectively categorizes any abnormalities in the cells. An HPV test, on the other hand, is a nonsubjective test to check for certain high-risk types of HPV, Barroilhet says. She explains that Pap smear analysis is a less precise science than HPV testing. \u201cThere\u2019s a subjective component to it that\u2019s going to make it a little less accurate,\u201d Barroilhet says. That\u2019s why false-positive results occur occasionally in Pap smears, but they\u2019re extremely rare in HPV tests.<\/span><\/p>\n

To ensure accurate results, the <\/span>American College of Obstetricians and Gynecologists<\/span><\/a> says to avoid douching, intercourse and any vaginal medications for two days before your screening. You should also avoid scheduling your exam during your period. If your screening lands when your flow is heavy, see if you can reschedule. But if you\u2019re only lightly spotting, it\u2019s OK to keep your appointment, Cepin says. <\/span><\/p>\n

Guidelines for Pap and HPV testing<\/h3>\n

Pap smears used to be a yearly milestone for most adult women. But <\/span>in 2012<\/span><\/a>, the U.S. Preventive Services Task Force released new guidelines indicating that women ages 21 to 65 only need a Pap smear every three years, and that women ages 30 to 65 can choose to wait even longer \u2014 every five years \u2014 if they receive both Pap and HPV testing. In August 2018, the guidelines were <\/span>updated again<\/span><\/a> to reflect a third choice for women 30 and over: HPV testing alone, every five years.<\/span><\/p>\n

Pap smear use in the U.S. is still only \u201cslowly aligning with 2012 guidelines,\u201d according <\/span>a 2017 study.<\/span><\/a> The idea of longer intervals between tests left some women feeling uneasy; shouldn\u2019t frequent testing lead to earlier detection of cancer? But too much testing can cause more harm than good, resulting in unnecessary follow-up appointments and invasive procedures to treat infections that would otherwise clear up on their own. \u201cWe don\u2019t want to know about transient changes that are going to go away on their own for the most part,\u201d Cepin says. \u201cIt\u2019s safe to wait that period of time between tests.\u201d<\/span><\/p>\n

The benefit of HPV testing alone for the 30-to-65 group is that it can help avoid false-positive results and unnecessary follow-up appointments, explains Dr. <\/span>Diane M. Harper<\/span><\/a>, a professor of family medicine at the University of Michigan.<\/span><\/p>\n

\u201cWhen we use just the HPV test, we are much more likely to target the women who are truly at risk and are truly abnormal,\u201d she says. Co-testing with both Pap and HPV testing is more likely to yield a false positive, which occurs when cervical cells collected during a Pap smear are identified as \u201cabnormal\u201d but are ultimately found not to be cancerous or precancerous. <\/span><\/p>\n

In that case, women \u201cstill have to go through the colposcopy and biopsy to find out they\u2019re normal and don\u2019t have anything,\u201d Harper says. \u201cThat is the harm in doing the co-testing.\u201d<\/span><\/p>\n

For women under 30, the CDC and the U.S. Preventive Services Task Force do not recommend routine HPV testing, since <\/span>HPV is so prevalent among women in their 20s<\/span><\/a> and most cases clear up on their own.<\/span><\/p>\n

There are <\/span>a few exceptions<\/span><\/a> to the testing recommendations. Some women, including those with weakened immune systems, may need more frequent testing. Women who have had a hysterectomy with cervix removal may not need any screening at all.<\/span><\/p>\n

If you\u2019re not sure which guidelines apply to you, talk to your doctor to determine the screening interval and tests that best fit your needs.<\/span><\/p>\n

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My Pap smear came back abnormal, or I tested positive for HPV \u2014 now what?<\/h3>\n

Don\u2019t panic. A one-off abnormal Pap smear or positive HPV doesn\u2019t mean you have or will ever develop cancer. <\/span><\/p>\n

\u201cAlmost everyone has an abnormal Pap over the course of their lifetime,\u201d Barroilhet says. \u201cBut it\u2019s persistent abnormalities or persistent HPV positivity that are going to indicate risk of dysplasia, and that\u2019s when additional evaluation needs to happen.\u201d<\/span><\/p>\n

If you\u2019re between 30 and 65 and have received abnormal Pap or HPV test results, your doctor may order a colposcopy, which is a procedure to visually examine the cervix with a bright light and magnifying lens. For women under 30 who receive an abnormal Pap smear result, your doctor will determine the best course of action, whether that means a repeat Pap smear or an HPV test. If you then receive an HPV test that comes back positive, your doctor may order a colposcopy.<\/span><\/p>\n

Undergoing a colposcopy is a lot like getting a Pap smear, Harper says, except that the speculum stays in the vagina longer. If your doctor sees any abnormalities, she\u2019ll take a biopsy from the cervix, which Harper says feels like a quick pinch. <\/span>After a biopsy, it’s normal to experience some<\/span> cramping, spotting or dark discharge<\/span><\/a> for a few days.<\/span><\/p>\n

Interpreting biopsy results<\/h3>\n

Biopsy results are categorized by level of severity, and different categorizations come with different follow-up and treatment protocols. <\/span><\/p>\n

You may hear your doctor refer to cervical intraepithelial neoplasia, or CIN, or cervical dysplasia; both terms are used to talk about abnormal precancerous cells. Cervical biopsies are classified by their CIN.<\/span><\/p>\n