The Rules Around Pap Smears Are Changing Again — Here's What You Need To Know

Photographed by Megan Madden.
Today, the U.S. Preventive Services Task Force announced new cervical cancer screening guidelines for people between the ages 30 to 65. The biggest change that you need to know about? If you're in that age range, you don't need to get a HPV test and a pap smear at the same time. In the past, doctors would do both of these tests together, called "co-testing." But according to the Task Force, this isn't the most effective and efficient way to screen for cervical cancer anymore — at least for this age group.
When the Task Force looked at research about the effectiveness of different screening tests in relation to a patient's age, they found that after age 30, the pap test and high-risk HPV (hrHPV) tests are both effective for cervical cancer screening, Maureen Phipps, MD, MPH, Task Force member said in a press release. Performing the two tests together didn't result in fewer deaths. "Women ages 30 to 65, therefore, have a choice between the pap test every three years or hrHPV test every five years," Dr. Phipps says.
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For a patient up in the stirrups, there's not a huge difference between a pap test and an HPV test, so this change toward getting one instead of both amounts to the difference between having one swab on your cervix and two, Stephanie Blank, MD, director of women's health, Mount Sinai Downtown Chelsea Center and professor of obstetrics, gynecology and reproductive science at the Icahn School of Medicine said in a press release. For some, it could mean waiting five years for an hrHPV test rather than stopping by for another pap in three. But the tests themselves look for very different things.
A pap smear looks for any abnormalities in the cells that are scraped off the cervix, Dr. Blank says. An HPV test, on the other hand, just tests for the presence of that virus. The reason why women ages 21 to 29 don't get a HPV test along with a pap smear, according to the American Cancer Society, is because HPV is so common. While almost all cervical cancers are caused by HPV, not all HPV will turn into cervical cancer, according to the National Cancer Institute. If the millions of people who have HPV received a positive test along with a regular pap, then they would all be shook about what that would really mean for their cancer risk. However, if you're someone who had an abnormal pap, then HPV testing would be a beneficial next step, to determine whether you're at risk for developing cervical cancer.
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If it feels like "the rules" around pap testing keep changing, you're not wrong. That's the whole point of the Task Force. "The group that put this together focuses on cost and looking at ultimate outcome of lives saved," Dr. Blank says. Their guidelines help insurance companies determine which tests to pay for, too, which is a good reason to stay up-to-date on the latest. This round, for instance, is still up for debate — anyone can leave a comment about it until October 9, before the final version is published.
Dr. Blank says it's important to keep in mind that, "[These] guidelines don't go for every patient," and it's up to you to discuss what makes sense for your body with your doctor. For example, if you're someone who's already at high risk for cervical cancer (because you're HIV-positive or have a family history), then your doctor will probably have a specific suggestion for you. There are plenty of health considerations they'll look at before choosing to only give you a pap or only an HPV test, which is why it's important to really talk about your big picture health.
The TL;DR of all of this: Get your HPV vaccine, get your pap smear, and follow up if anything's abnormal. "A pap smear alone doesn't really save lives," Dr. Blank says. "If you have an [abnormal] pap smear and follow up appropriately — that's when lives are saved."
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