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Pap Smear, HPV Test, or Both?

Pap smear test

The pap smear (or pap test) is one of the cornerstones of women's health. It was introduced in the 1940's as a way to screen for abnormal cervical cells. Starting at the age of 21 women are recommended to get one every three to five years depending on their age and cancer risk. "What we are looking for is called cervical dysplasia," said Melani Harker, MD, a gynecologist with University of Utah Health. "These are cells that are not yet cancerous, but have the potential to be. By identifying them with a pap test we can treat them before that happens."

In the decades since the development of the pap smear much more has been learned about cervical cancer and its causes. The biggest discovery involves the human papilloma virus (HPV), a sexually transmitted disease, which we now know is the primary cause of cervical cancer. An HPV screen was introduced in 2006 and began being widely administered a little over a decade ago. "This test is administered like the pap test," said Harker. "But instead of looking at cells it is looking for strains of HPV that could cause cancer."

So, now we have two tests: one that tests for potentially cancerous cells, and one that tests for the virus that causes those cells. That has some in the health care industry asking if both are really necessary. Could a physician just test for HPV since it is the primary cause of the abnormal cells detected by the pap smear? "The testing done together is an accurate evaluation of the cervical health," said Harker. "A normal pap test usually means an HPV test isn't needed, especially in younger women."

Women younger than 26 should be vaccinated against HPV - eliminating the need for an HPV test altogether. The vaccine is available starting at age 11 and is a series of three doses given over a short time period. And girls aren't the only ones who should be vaccinated. "Boys should also be protected against HPV," said Harker. "In addition to cervical cancer HPV can cause cancers of the throat, anus and rectum."