Pap smears might soon become a thing of the past during gynecological exams for some women, based on a new draft recommendation from the U.S. Preventative Services Task Force. They now suggest high-risk human papillomavirus (HPV) testing every five years as the preferred method for cervical cancer screening for women aged 30 to 65.
For women aged 21 to 29, Pap smears every three years will continue to be the recommended testing method. The Task Force has discovered new evidence indicating that primary HPV screening for women aged 30 to 65 is the better choice, as it offers a more favorable balance between benefits and potential drawbacks in cervical cancer screening.
Women over 30 aren’t completely done with Pap smears—they can still choose to have a Pap smear every three years or opt for a combined Pap smear and HPV test every five years, which is known as co-testing. The updated guidelines also introduce the option of self-collection, allowing women aged 30 to 65 to collect their own HPV sample at the doctor’s office. This new approach aims to remove barriers and expand access to screening, especially for those who have never or rarely been screened.
Certain groups do not need cervical cancer screening, including women under 21 years old, women over 65 with a history of regular testing and normal results, and women of any age who have had a total hysterectomy. Otherwise, this guidance applies to everyone assigned female at birth, including transgender men and nonbinary individuals.
Now, you might be curious about the differences between Pap smears and HPV tests, the reason for the Task Force’s change in recommendations, and which test you should choose. Here’s what you need to know. Both Pap smears and HPV tests are used to screen for cervical cancer and require a sample of cervix tissue, but the sample is examined differently for each test.
In a Pap smear, the sample is examined under a microscope for abnormal cells that might turn into cervical cancer. A physician must collect the sample during a pelvic exam, as it needs to be taken from a specific area of the cervix where cancer is most likely to start. The physician can also visually inspect for any abnormalities.
Since the 1940s, Pap smears have been the main screening tool for cervical cancer. But in 2003, the American Cancer Society and the American College of Obstetricians and Gynecologists approved HPV tests as an option for women 30 and older. HPV tests check DNA samples for HPV infections, which are responsible for nearly all cervical cancer cases. Unlike Pap smears that look for cancerous cells, HPV tests search for specific HPV strains that could cause cervical cancer.
Because HPV tests only need a DNA sample, they can be collected without a pelvic exam, allowing for self-collection by patients. Traditionally, HPV tests were done alongside Pap smears during pelvic exams, but now they can be collected through a self-collection method, where a patient uses a Q-tip-like swab to get a sample.
The recommendation for primary HPV testing for women aged 30 to 65 is linked to the nature of HPV and its progression to cervical cancer. HPV infections can take many years to develop into cervical cancer. A person in their 20s might contract an HPV infection, which is common for sexually active individuals, but their immune system likely manages the virus before it becomes cancer. That’s why Pap smears are suggested for women in their 20s; the immune system typically handles HPV, but screening for cervical cancer signs is still necessary.
Once women reach their 30s, a positive HPV test is more associated with a long-standing infection, which increases the risk of cervical cancer. Doctors can use the same sample for a Pap smear if a positive HPV result occurs, checking for cancer signs. This approach helps avoid unnecessary stress and tests when minor abnormalities are found in someone who’s HPV negative.
The Task Force designed their recommendation to limit harm and provide clarity on the best testing option for each age group. Their changes aim to ease confusion and improve screening access while ensuring that Pap smears, HPV tests, and co-testing all remain effective and accurate methods for cervical cancer detection. Notably, regular screening is crucial, as most women who develop cervical cancer are those who do not get tested regularly.
Preventing cervical cancer through an HPV vaccine is still vital. The vaccine is generally recommended for those up to 26 years old and, in some cases, up to age 45. When it comes to the new screening guidelines, exceptions might exist for any healthcare advice, so having a conversation with your doctor is essential.
