Q. I’m 50 years old and have never had an HPV test. Do I need one as part of my health screening?
A. The short answer to your question is, no, you don’t need the HPV test for routine cervical cancer screening. However, it’s complicated, and there have been some changes in screening guidelines for cervical cancer that women should know about.
The HPV test detects the presence of certain strains of the human papilloma virus (HPV) that are thought to cause most, if not all, cases of cervical cancer. The virus is found in cervical cells and can be identified in a specimen collected much like a Pap.
There are many types of HPV, some of which cause genital warts, but only a few of them have been linked to the development of cervical cancer. HPV is sexually transmitted and very common among sexually active women and men. Most of the time, the body’s immune system gets rid of the virus before it does any harm, but some strains can linger in cervical cells and cause changes that may eventually develop into cancer.
Most women with a positive HPV test don’t have cervical cancer and will not develop it. But having high-risk HPV does determine a woman’s risk for cervical cancer. Consequently, the HPV test is used to decide how often a woman should have Pap smears — and whether a woman with a minimally abnormal Pap (that is, a Pap that shows “atypical squamous cells of undetermined significance,” or ASC-US) needs further testing.
Current guidelines suggest that women ages 30 and over who are at low risk for cervical cancer and have had three consecutive normal Pap smears may want to have cervical cancer screening every two to three years instead of more often. If you have a negative high-risk HPV test at the same time as a negative Pap, you don’t need to be rescreened for three years. On the other hand, women known to be at high risk for cervical cancer should continue to have a Pap test every year. These include women who have been exposed to diethylstilbestrol (DES), women who are HIV-positive or immune-compromised, and women who have had cervical dysplasia or neoplasia.
For women under age 30, routine HPV screening doesn’t make sense, because they usually eliminate HPV infections. In these younger women, a positive result could lead to unnecessary concern and follow-up testing.
— Celeste Robb-Nicholson, M.D.
Editor in Chief, Harvard Women’s Health Watch