Since 2012, gynecologists have asked women to schedule a Pap smear every three years, instead of annually. But is it time for a further change?
In recent years, some gynecologic oncologists have proposed replacing Pap smears with an “upstream” cervical cancer screening method. Instead of testing broadly for abnormal cells, women would be screened for human papillomavirus (HPV), the root cause of almost 12,000 new cases of cervical cancer each year.
A woman could be screened for HPV every three years, with a positive HPV test warranting follow-up colposcopy or cytology testing, recommends an interim guidance report from the Society of Gynecologic Oncology and the American Society for Colposcopy and Cervical Pathology.
“The downside to a Pap smear or cytology is it’s not as sensitive for picking up cervical dysplasia as HPV typing is,” explains S. Diane Yamada, MD, chief of gynecologic oncology at University of Chicago Medicine. “You may miss women who have high-risk HPV changes.”
Although countries like Australia and the Netherlands already use a similar HPV framework, the U.S. Preventive Services Task Force only okays screening methods that include a Pap smear. There are some concerns about switching from the Pap to the HPV test, including the higher costs of HPV tests and the fact that a positive HPV test might not predict whether the virus will ever cause cervical cancer.
“I do think, in certain women, HPV tests can replace the Pap smear,” Yamada says. “But I don’t think [the Pap smear] should be considered completely obsolete right now.”
