What’s the difference between an HPV test, a Pap test, and an HPV/Pap cotest?
A Pap test, often called a Pap smear, looks for abnormal cells that can lead
to cancer in the cervix. An HPV test looks for the human papillomavirus, a
virus that can cause cervical cancer. For an HPV/Pap cotest, an HPV test and
a Pap test are done together.
For a patient at the doctor’s office, an HPV test and a Pap test are done the
same way—by collecting a sample of cervical cells with a scraper or brush.
The Pap test has been the mainstay of cervical cancer screening for decades.
HPV tests are a newer method of cervical cancer screening. Two HPV tests have
been approved by the Food and Drug Administration (FDA) for use as a primary
HPV test, meaning it is not part of an HPV/Pap cotest. Other HPV tests are
approved as part of an HPV/Pap cotest.
Why does the new guideline recommend an HPV test over a Pap test or HPV/Pap cotest?
All three tests can find cervical cancer precursors before they become cancer.
But studies have shown that HPV tests are more accurate and more reliable than
Pap tests. Also, you can rule out disease really well with HPV tests so they
don’t have to be repeated as frequently.
Although the Pap test has led to huge drops in rates of cervical cancer and
death from the disease, it has some limitations. Pap tests have lower
sensitivity compared with HPV tests, so they may miss some precancers and have
to be repeated frequently. They also detect a range of abnormal cell changes,
including some minor changes that are completely unrelated to HPV. So, many
people who get an abnormal Pap test result actually have a very low chance of
developing cervical cancer.
HPV/Pap cotesting is only slightly more sensitive than HPV testing, but it
is less efficient because it requires two tests. And it detects a lot of
minor changes that have a very low risk of turning into cancer. For an entire
population, that’s a lot of additional effort and cost.
Screening with an HPV test alone was not recommended by ACS in 2012 because
that approach wasn’t yet approved by FDA. The 2018 USPSTF guideline included
HPV testing alone, cotesting, and Pap testing as equal options. The difference
in the new ACS guidelines is that they elevate HPV testing alone over the
other two tests.
Why does the new guideline recommend screening starting at age 25, instead of 21?
Using information from new studies, ACS concluded that the benefits of cervical
cancer screening do not outweigh the harms for people aged 21 to 24 years old.
ACS recommends cervical cancer screening with an HPV test alone every 5 years for
females with a cervix from age 25 until age 65. If HPV testing alone is not
available, people can get screened with an HPV/Pap cotest every 5 years or a Pap
test every 3 years.
Not crucial for virgins to get tested
These recommendations differ slightly from those given by ACS in 2012 and by the
US Preventive Services Task Force (USPSTF) in 2018Exit Disclaimer.
2020 ACS 2012 ACS 2018 USPSTF
Age < 21‒24 No screening Pap test every 3 years Pap test every 5 years
Age 25‒29 HPV test every 5 years (preferred) HPV/Pap cotest every 5 years (acceptable)
Age 30‒65 HPV test every 5 years (preferred) Pap test every 3 years (acceptable)
Age 65 < and elder No screening if a series of prior tests were normal
https://www.cancer.gov/news-events/cancer-currents-blog/2020/cervical-cancer-screening-hpv-test-guideline
Be sure you stress to the OBGYN if you're virgin
(especially if you haven't even used tampons)