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Harvard Medical School
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Question : I am 29. I have always had normal PAP smears. I just read that HPV testing might be better. What do you suggest? If I just get HPV tests, how often do I need it repeated?
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The Trusted Source
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Howard LeWine, M.D.

Joan Marie Bengtson, M.D., is assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School and a member of the Department of Obstetrics, Gynecology & Reproduction at Brigham and Women's Hospital.

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May 02, 2014
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Screening for cervical cancer with Pap smears has led to a dramatic decrease in the incidence of the disease. 

But all screening tests have limitations. So the decision to recommend one test over another is based on choices about the test’s risks and benefits. 

A woman’s age, medical history, and sexual habits determine her risk of cervix cancer.  So, all women should speak with their doctor. And discuss a screening program that is best suited to their situation. 

Until fairly recently all cervical cancer screening was by Pap smear.  This is a collection of cervical cells that are inspected by microscope for evidence of abnormal growth.

Cells are classified as:

  • Normal
  • Atypical
  • Having low grade changes
  • Or having high grade changes

If high grade changes are found, the patient is advised to have a colposcopy. This is a test that magnifies the cervix for closer assessment. Abnormal areas of the cervix are then biopsied. And treatment to remove the abnormal areas is planned.

Infection with human papilloma virus (HPV) is the main risk factor for cervical cancer.  This knowledge is opening up new options for screening using detection of HPV.

Until recently HPV testing was only used along with Pap smear testing to clarify risk in women with atypical cells on Pap smear. The FDA has now approved using the HPV test for screening instead of Pap smears. But this is only true for women over age 24. 

Most guidelines still recommend using Pap smears for primary screening. It is likely that the guidelines will evolve over time. 

The advantage of primary screening with HPV over Pap smears is that the detection of the virus is much more sensitive. But most infections with HPV — especially in young women — will go away without treatment. Thus the concern for primary screening with HPV is that it will result in more women undergoing unnecessary colposcopy and treatment than if Pap smears are used as the first screening test. 

The recommended interval between cervical cancer screening tests is also evolving. These are the current guidelines from the US Preventive Services Task Force (USPSTF):

  • Ages  younger than 21. Cervical cancer screening is not recommended.
  • Ages 21 to 29.  Pap smears every three years.
  • Ages 30 to 65. Pap smears every three years or screening by a combination of Pap smear and HPV testing every five years.
  • Age 65 and over. Screening is not recommended if recent Paps are normal.

 

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