Prevent Cervical Cancer – The Latest Pap and HPV Testing News
By Dr. Erin Lauer
You may have heard in the news over the last several years that pap smears aren’t necessary every year. But what does that mean and why? Why wouldn’t we do pap smears every year? What is the point of a pap smear, anyway? Hopefully, I’m able to answer some of those questions below.
Are a pap smear and a pelvic exam the same thing?
A pelvic exam involves two parts: 1) a “bimanual” exam where two fingers are inserted into the vagina and the provider feels the size and shape of the uterus and ovaries using the hand in the vagina and a hand on the abdomen; and 2) a “speculum” exam — with “that duck bill thingy” — which allows your provider to see your cervix (opening of the uterus) and the walls of your vagina.
A pap smear is a cell sample from the end of your cervix. This is collected using a small brush, and the cells collected on the brush are put in a special solution and sent to the lab. A pathologist a physician trained in looking at cells and tissues under a microscope) then looks at the cells and says if they have any atypical components or signs of dysplasia— in other words, the pathologist describes how “funny” the cells look and if they look like they might be precancerous or cancerous.
For most women over the age of 30 and some women below 30, those cells in a pap smear are also tested for certain strains of a virus called HPV, which is reported on the pap smear results along with how “funny” the cells look. So, in conclusion: you must have a pelvic exam to have a pap smear (your provider needs to use a speculum to see the cervix to perform a pap), but pap smears are not performed at all pelvic exams.
What is HPV and why/when do we care?
HPV (or human papilloma virus) is a type of virus that lives in human genital tracts in both men and women. In women, it primarily lives in the cervix, but can also live in the vulvar tissue and vaginal tissue. There are many strains of HPV, and most of them don’t do much of anything to us. Just about anyone who has ever had sex has some strain of HPV, but we don’t test for most strains because there’s no reason to — they aren’t hurting us.
However, there are a few strains that can cause problems. Some strains can cause genital warts, and some strains can put people at risk of cancer. The strains that can cause cervical cancer cause the changes in cell appearance that pathologists pick up on under the microscope and report as an abnormal pap smear result, like we discussed above — and they are also the strains that we test for in the HPV testing that goes along with pap smears for some women. If those abnormalities are never discovered or are left untreated, then over time (typically 10+ years), they can progress to cervical cancer.
We don’t usually test for the high risk strains of HPV in women below age 30 because our data shows that those women’s bodies are likely to get rid of the HPV strains before they can cause any kind of issue — and we prefer not to put women through additional procedures and biopsies if they aren’t actually necessary to preventing cervical cancer.
Ask your gyn provider if you have any questions about the safest way to ensure you don’t get cervical cancer.
What are the current guidelines for “cervical cancer screening” and why do they keep changing?
“Cervical cancer screening” is the category of tests that we use to identify people who may have cervical cancer. The initial tests you may get include the pap smear, the pap smear with HPV test (sometimes referred to as “cotesting”) and an HPV test alone. Typically for most women, your gyn provider will recommend a pap smear every three years from age 21 to age 29, and then cotesting every 5 years from age 30 to age 65. Reasons they may recommend a different schedule for you include a history of abnormal pap/HPV testing or a disease that causes severe immunocompromise, such as HIV.
If you have any abnormalities on your testing, your provider should follow the ASCCP (American Society for Colposcopy and Cervical Pathology) guidelines. The ASCCP is the leading organization of experts who study cervical cancer screening. These guidelines have evidence-based recommendations for what to do after an abnormal result.
The guidelines try to maximize two goals: 1) prevent youfrom developing cervical cancer; and 2) avoid performing unnecessary tests/procedures which won’t actually help you. These guidelines get updated frequently and were most recently updated this year.
So, if things seem different than they used to be, it is because your gyn providers are trying to take better care of you and stay up to date!
What if I have an abnormal pap?
The next steps depend on how abnormal the pap smear is, what your HPV testing showed, your age, any history of prior abnormal paps, and perhaps a few other pertinent details from your medical history. However, almost all abnormal paps do mean that you will have closer follow up than the 3 year or 5 year interval between paps recommended for most women.
Based on your testing and your clinical picture, you may need a repeat pap sooner, or you may need a procedure called a colposcopy, routinely performed in the office. This involves putting acetic acid (AKA vinegar) on the cervix, which helps us see abnormal areas, looking at it with a special instrument that provides magnification, and frequently taking biopsies (typically 2-3mm pieces) off of the surface of the cervix. These are sent to the pathologist to look at under a microscope, and they give more details about how abnormal/precancerous the cells are. These biopsies are more involved and uncomfortable to obtain than a pap smear, which is why we don’t do them for everyone.
If these biopsies show precancerous changes, we may recommend a procedure called a LEEP (loop electrosurgical excision procedure), also performed in the office, where the lowest portion of the cervix is removed, hopefully removing the entire area of abnormal cells before they progress to cancer.
Ask your gyn provider if you have any questions about the safest way to ensure you don’t get cervical cancer. For many cancers (like lung, ovarian, breast, pancreatic cancer, and many more), people often have advanced cancer before they have any symptoms or testing abnormalities.
Cervical cancer is unlike those cancers, though, in that we can completely prevent it with the pap and HPV testing currently widely available.
If it’s been more than 5 years since you’ve had a pap or you’ve had abnormal results in the past, reach out to your gyn provider about next steps in cervical cancer screening; remember, we’re in this together.