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Home Ask the Experts Ask the Experts Is a Pap test enough?

Is a Pap test enough?

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I don't understand the difference between Pap tests and HPV tests. Don't they look for the same things? My Paps have ALWAYS been normal, but at my clinic they say they're starting to use HPV tests for "older" women (as if! I'm 32). Wouldn't just my regular Pap be good enough?

After all these years of telling women they need a yearly Pap test, we've gone and changed the "rules” so no wonder you're confused! Let me start with a review of these screening tests.

The Pap test was developed about 60 years ago. A gentle scraping of the cervix accumulates cells that are sent to the lab for review under a microscope. There, the cells are examined for any characteristics that might indicate abnormal cell growth. The results are then reported in a category that corresponds to the degree of abnormality seen. This cellular test has been the cornerstone of cervical cancer screening in the United States.

The HPV test has only been available for less than 10 years. It is considered a molecular test since it tests for the presence or absence of HPV DNA. Only the high risk" strains should be tested for since they are the ones that cause pre-cancers and cancer. It can be tested from the residual of the liquid- based PAP test, or by itself with a small collection brush. The results are reported as positive (meaning high risk DNA has been detected) or negative (meaning high risk DNA has not been detected).

New guidelines for screening now have an option for women age 30 and older by screening with both a PAP test and an HPV test. Rates of HPV are lower in this age group, but the incidence of cervical cancer begins to go up. This may be because some women do not clear the HPV infection they acquired years before. By using an age specific test (the Pap test) and a sensitive test (HPV DNA) together, you get the benefit of a highly effective screen for pre-cancers and cancer.

If both of these tests are negative, you are at the lowest risk category for developing cervical cancer and can safely lengthen the interval that you are screened to every 3 years.

Beth Colvin Huff, MSN, FNP-BC
Vanderbilt University Medical Center