What to Know Before Your Next Gyno Visit

Pap smears may be a thing of the past during gynecological exams for some women, according to a new draft recommendation from the U.S. Preventative Services Task Force.

Now, the USPSTF is recommending high-risk human pappilomavirus (HPV) testing every five years as the “preferred screening strategy” for cervical cancer in women ages 30 to 65.

Cervical cytology tests—more commonly known as Pap smears—every three years will remain the preferred testing method for women ages 21 to 29.

“We have new evidence that highlights that HPV primary screening for women ages 30 to 65 is the preferred strategy, because the evidence shows it has a better balance of benefits to harms when screening for cervical cancer,” Task Force vice chair John Wong, MD, MACP, a professor of medicine at Tufts University School of Medicine, told Health.

The new recommendations don’t completely outlaw Pap smears for women over 30—they can still opt for a Pap smear every three years, or a combined Pap smear and HPV test every five years (known as co-testing).

The USPSTF’s updated recommendations also include the option of self-collection for cervical cancer screening, allowing women ages 30 to 65 to swab their own HPV sample in the doctors office.

“It’s an exciting new change,” Jessica DiSilvestro, MD, a gynecologic oncologist at Tufts Medical Center, told Health. “The goal of its introduction is to decrease barriers to screening and increase access, especially for never-screened or under-screened populations.”

Some groups do not need to be screened for cervical cancer, including: women under 21 years old, women over 65 who’ve had regular testing with normal results, and women of any age who’ve had a total hysterectomy.

Otherwise, this recommendation applies to everyone who was assigned female at birth, including transgender men and nonbinary people.

You might be wondering what the difference is between Pap smears and HPV tests, why the Task Force changed it’s recommendation, and which test you should get. Here’s what you need to know.

Pap smears and HPV tests are the two screening methods for cervical cancer. They both require a sample of tissue from the cervix, but that sample is examined differently in each test.

“It’s called a Pap smear, because you would literally take your spatula, scrape it across the cervix, and then smear that tissue or cell onto a microscope slide,” Sarah Tout, MD, assistant professor of reproductive biology at Case Western Reserve University School of Medicine, told Health.

In a Pap smear, the sample is looked at under a microscope to check for any abnormal cells that may develop into cervical cancer.

A physician has to collect the sample during a pelvic exam, Tout explained, because the tissue has to be taken from a specific spot on the cervix where cancer is most likely to develop. There is also a visual component, as the physician can check for any abnormalities that they can spot with a naked eye.

Pap smears have been the primary screening method for cervical cancer since the test was introduced in the 1940s. In 2003, the American Cancer Society and American College of Obstetricians and Gynecologists recommended HPV tests as an option for screening women 30 years and older.

HPV tests, on the other hand, check DNA samples for the presence of HPV infection, which cause nearly all cases of cervical cancer. Instead of checking for potentially cancerous cells like a Pap smear, HPV tests look for the certain HPV strains that could cause cervical cancer. “One is testing for the virus. The other is like a picture or a snapshot in which we’re looking at the cells,” Wong said.

Since HPV tests only require a DNA sample, they can be collected blind without a pelvic exam, opening the door for patient-collection.

“The HPV test has typically been collected at the same time as the Pap smear through a pelvic exam, but now can be collected through a self-collection technique,” DiSilvestro said. “In the self-collection method, a patient inserts a Q-tip like swab into the vagina to collect a sample.”

The reason HPV tests are now the primary screening recommendation for women ages 30 to 65 has to do with the nature of the HPV virus and how it causes cervical cancer.

It takes years for HPV infections to turn into cervical cancer. Even if a patient gets an HPV infection in their 20s, which is common for all sexually active people, their immune system is likely to control the virus before it causes cancer. “HPV can, in most women, be a transient infection, meaning that a woman’s immune system kicks in, and over time, eradicates that infection,” Wong explained.

That’s why the Task Force recommends that women in their 20s stick to a Pap smear; their immune systems will likely manage an HPV infection, but they still need to be screened for signs of cervical cancer. Checking for HPV first just causes confusion. “By screening with HPV, we potentially could lead to more follow-up tests and procedures that would have been unnecessary,” Wong added.

Once women are in their 30s, Wong said, it’s more likely that a positive HPV test means they’ve had the infection for years, bringing a greater risk of cervical cancer. After the positive HPV result, physicians can use the same tissue sample for a Pap smear and check for signs of cancer.

The Task Force has recommended this strategy to avoid undue harm. “You can really introduce confusion when you get a slightly abnormal [Pap smear] result in someone who’s HPV negative,” Tout said. “The vast majority of the time it just kind of causes a lot of stress for the patient without being of any benefit to their health.”

While the Task Force primarily made its new recommendation for physicians, Wong said they hoped to provide clarity to patients about the best testing option for their age group.

Wong said the changes were made to reduce confusion and barriers to screening, but all three methods—Pap smears, HPV tests, and co-testing—are accurate and effective in screening for cervical cancer.

“Most women who develop cervical cancer are those who are not regularly screened,” Wong said, stressing that the most important takeaway for patients is to get tested.

Tout also mentioned that the best way to prevent cervical cancer is with an HPV vaccine, which is generally recommended up to 26 years old.

As for the new screening guidelines, there will be exceptions to any healthcare recommendation, Tout said, “but at the end of the day, you need to have a conversation with your doctor.”