Ask Dr. K: Cervical cancer screening has changed

DEAR DOCTOR K: I am 31 years old and have always had normal Pap smears. I just read that HPV testing might be better. What do you suggest?

DEAR READER: Screening for cervical cancer has led to a dramatic decrease in the disease. Until fairly recently, all cervical cancer screening was done by Pap smear. But the FDA recently approved the use of a new screening tool – the HPV DNA test – that may eventually take its place.

Most cases of cervical cancer or precancerous cervical changes are caused by the human papillomavirus. There are more than 100 different types of HPV; some (but not all) types of HPV can cause cervical cancer.

Until recently, HPV DNA tests were only used together with Pap tests. If a woman’s Pap test found abnormal cervical cells, HPV DNA tests could identify whether the woman carried the types of HPV more likely to cause cervical cancer.

The problem with that strategy is that the Pap test is not perfect. There are women who have an HPV infection that is causing cervical cancer (or a precancerous condition) but who have a “normal” Pap test. If the Pap is falsely negative, the HPV test wouldn’t be ordered.

The FDA has now approved the HPV test for screening in place of Pap smears in women age 25 and older.

But there’s a problem with HPV testing, as well. Most HPV infections – especially in young women – go away without treatment and do not lead to cancer. So many HPV tests will be abnormal in women who don’t have cancer.

In general, I follow the guidelines on cancer screening issued by the U.S. Preventive Services Task Force.

Currently, the panel recommends:

• 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.

• Ages 65 and over: Screening is not recommended if recent Pap tests are normal.

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