Each year, approximately 12,000 women are diagnosed with cervical cancer in the United States. In most cases cervical cancer can be prevented through early detection and treatment of abnormal cell changes that occur in the cervix years before cervical cancer develops. We now know that these cell changes are caused by human papillomavirus, commonly known as HPV. The traditional test for early detection has been the Pap test. Now tests for HPV are available that can be used with the Pap test in women starting at 30 years of age and in women of any age when the Pap test alone has found slightly abnormal cell changes.
Recently one HPV test—the cobas® test—was approved for use with women age 25 and older for primary cervical cancer screening (meaning it can be done alone without a Pap test). With HPV primary testing, women who test positive for high risk HPV will than have a Pap test, while those positive for the more aggressive HPV 16 and HPV 18 will be referred for colposcopy (where a health care provider uses a special lighted microscope to examine a woman’s cervix directly).
It’s also acceptable to continue screening women with Pap tests alone. The most common abnormal Pap result is called ASC-US, or atypical squamous cells of undetermined significance. About half of the women with ASC-US have these cell changes because of the presence of HPV, while the other half do not. Women with ASC-US Pap tests often have a follow-up HPV test: if the HPV test is negative, you probably will continue with normal, routine screening. Usually only women with ASC-US who test positive for HPV need further evaluation. HPV testing is helpful at any age for determining which women with ASC-US need follow-up.
Another option is to have an HPV 16/18 Genotyping test that checks directly for HPV types 16 and 18, which together are responsible for approximately 70% of cervical cancers. This test is approved for use (in combination with a Pap test and Cervista HR test) as primary cervical cancer screening with women age 30 and older to determine if HPV 16/18 are present with ASC-US Pap results.
Key Points to Remember
Almost everyone gets HPV at some time. HPV is not likely to change your life. If you have tested positive for HPV there may be a short period of time during which follow-up may seem to be a bother, but little more. Cervical cancer, the most serious problem associated with HPV, is rare and almost always prevented through regular testing for cervical cell changes that could lead to cancer.
Cervical cancer is preventable. Early detection of abnormal cell changes is important.Almost all women and men will have HPV at some point, but very few women will develop cervical cancer. The immune system of most women will usually suppress or eliminate HPV. Only HPV infection that does not go away over many years can lead to cervical cancer, for example.It can be helpful to know your HPV status. This can help determine how often your clinician will recommend that you be tested.Don’t blame yourself or your partner. Your HPV status is not a reliable indicator of your sexual behavior or that of your partner.