HPV stands for Human Papilloma Virus. There are over 150 types of HPV viruses, causing many different diseases in humans. Most people contract some type of HPV infection during their lifetimes. Most HPV diseases are mild and resolve spontaneously. Mild diseases are caused by low risk types of HPV, including types 6 and 11. However, infection with some types of HPV can lead to cancer, specifically of the cervix, throat, mouth, vulva, vagina, penis and anus. These cancers are caused by high risk HPV types with types 16 and 18 being the most prevalent.
History of the Pap test:
Cervical cancer was the leading cause of cancer deaths in women in the U.S. before the advent of widespread Pap testing for women. Dr. Georges Papanicolaou, a Greek pathologist who emigrated to the U.S. in the early 20thcentury, spent his professional career at Cornell University Medical College. He discovered that cells from a normal cervix vs. a cervix with a cancerous growth looked very different when viewed under a microscope. He conceived the idea that women could be checked for cervical cancer by examining a scraping of the cervix under the microscope and he invented a stain for this purpose. This stain is called the Pap stain in his honor. It was a revolutionary development in cancer screening which has far reaching consequences to this day.
The adoption of widespread screening for cervical cancer has led to a significant decrease in the incidence of cervical cancer in this country and the developed world over the past 70 years. In the mid-1970s, medical researchers understood that cervical tumors virtually always contained DNA (genes) from the Human Papilloma Virus (HPV). Thus the question arose: Does HPV cause cervical cancer? The short answer is ‘yes’ and today physicians and healthcare advocates all agree that early detection of HPV infection leads to reduced rates of cervical and other HPV-related cancers.
Cancer Screening Guidelines:
Guidelines for cancer screening are based upon rigorous research and testing. Currently, the Pap test is recommended for all women between the ages of 21 and 65 years of age. Before testing, a woman should not douche, use tampons, have sex, use birth control foam, cream or jelly, or use any other medicine, lubricant or cream in the vagina. Testing should be performed every 3 years if a Pap test is done and is negative. Testing should be performed every 5 years if a high risk HPV test is done and is negative. Co-testing refers to performing both the Pap test and the HPV molecular test from the same sample and is recommended in women between the ages of 30 and 65 to lengthen the testing interval from 3 to 5 years.
Even though these guidelines recommend spacing Pap or HPV testing at 3 to 5 year intervals, its important to understand these recommendations are for women who have no history of an abnormal Pap or HPV test. Women need to know that continuing to have an annual exam is very important to address all their health needs. This includes women who are not sexually active or who are menopausal.
New screening guidelines for cervical cancer will be released later in 2018. These guidelines have been tested to a high degree of certainty of benefit based on evidence from well-designed and well-conducted studies in representative primary care populations. The new guidelines recommend screening in women age 21 to 65 with Pap testing every 3 years, or, for women age 30 to 65 screening with high risk HPV testing alone. Thus, the current recommendation for co-testing will be withdrawn.
This new recommendation is an important advance in healthcare because it puts our available testing resources to its maximum utility, thus saving healthcare dollars and potential harm from over- or under-diagnosing disease.
Finally, I want to address the HPV vaccination, which is recommended for girls and boys beginning at the age of 11-12. Since we know that high risk HPV causes cervical, oral, anal, vaginal and penile cancers, then by reducing the prevalence of high risk HPV infections we also reduce the incidence and mortality of these cancers. This is the purpose of the HPV vaccine, which should be given before boys and girls are exposed to sexually transmitted infections. There are several formulations of the HPV vaccine, but all are designed to protect against the most common high risk types of HPV that are known to cause cancer.
Recommendations on cervical cancer screening are taken from the U.S. Preventative Services Task Force. For all women between the ages of 21 and 65, cervical cancer screening using either a Pap test every 3 years, or a combination of Pap test and high risk HPV testing (i.e., ‘co-testing’) every 5 years is currently recommended. These recommendations are currently being modified and new recommendations are expect within the year. Continue to see your doctor for your annual check-ups, even if you are not due for cervical cancer screening. Boys and girls should receive the HPV vaccine at the age of 11-12.