PAP & HPV Testing: More is not Better

The discovery that persistent cervical infection by sexually transmitted high-risk human papillomavirus (HPV) causes virtually all cervical cancer has led to revolutionary advances in cervical cancer prevention, including HPV vaccination for young women and HPV testing.

A recent article published in the Journal of Obstetrics & Gynecology found a number of disturbing patterns regarding overuse of HPV testing.  First, approximately one quarter of the surveyed clinicians ordered both high-risk and low-risk HPV tests. Testing for low-risk HPV offers no benefit to patients because these HPV types are unrelated to potential cervical cancer (though they can cause warts). Second, approximately 60% of the doctors reported routine testing for HPV for women under the age of 30, despite guidelines that strongly recommend against such testing because most occurrences of HPV in this age group have proven to be transient. 80% of women will contract HPV and most will clear it in short order thanks to their immune systems—just like a cold virus. Third, many practitioners are co testing (PAP & HPV) annually and biannually rather than triannually as recommended. Finally, high volumes of unnecessary PAP tests are being performed on women who receive no benefit from cervical cancer screening, such as hysterectomized women without a cervix, and young women who are not yet sexually active and thus have never been exposed to the HPV virus.  It was estimated that more than half of the 75 million Pap tests performed in the United States in 2010 were probably outside of guidelines and therefore unnecessary.

National guidelines for high-risk HPV DNA testing for the following indications:

  1. Conditional HPV testing of women if they have a borderline abnormal PAP.  This is appropriate for women undergoing screening in their 20’s. If the HPV is positive then further evaluation by her gynecologist is necessary.
  2. HPV testing should be used routinely in an addition to a PAP in women aged 30 years and older.  Women who test negative for both HPV and PAP are then screened at an extended interval of no less than 3 years because it excludes cervical cancer with an accuracy of over 99%. If women test positive for HPV then they are either rescreened in one year, or if their PAP is also abnormal then they undergo further immediate evaluation—called Colposcopy.
  3. HPV testing at 12-month follow-up visits for women who had previous pre-cancerous cervical changes or recent abnormal screening.

Here is a summary of cervical cancer screening:

pap-hpv-testing

Confused? Just remember it is very important that you have a yearly gynecologic exam irregardless of how often your PAP test is performed. After all, there is more of you to care for than just your cervix.