What Women Should Know

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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.

FAQs

What is the Pap test?

The Pap test finds changes in the cells of the cervix (the mouth of the womb) that are not normal. The test involves taking a small sample of cells from the cervix, usually during a routine pelvic exam. The cells are sent to a laboratory where they are prepared and evaluated under a microscope.


What is an HPV test?

HPV tests can find any of the high-risk types of HPV that are most commonly found in cervical cancer. The presence of any of these HPV types in a woman for many years can lead to cell changes that may need to be treated so that cervical cancer does not occur. The HPV test is done at the same time as the Pap test by using a small soft brush to collect cervical cells that are sent to the laboratory, or the HPV testing sample may be taken directly from the Pap sample.


What is HPV?

HPV is a virus that is very common. In fact, most men and women are infected with HPV at some time in their lives. There are approximately 100 types of HPV. Some HPV types typically infect the genital area and may cause warts, some cause mild changes in cervical cells that do not turn into cancer, and some cause changes that may become cervical cancer if present for many years. The types of HPV that are found in the genital areas are usually passed on during sexual contact (sexually transmitted). HPV types that cause warts on the hands or feet do not cause genital warts or cervical cell changes, nor do genital HPV types generally spread outside the genital area.


How common is HPV?

HPV is the most common sexually transmitted virus. It has been estimated that 75% or more of sexually active Americans will contract HPV sometime in their lives. This means that anyone who has ever had sexual relations has a high chance of being exposed to this virus, but only a small number of women infected with HPV develop cell changes that need to be treated. In almost all cases, the immune system will keep the virus (including the cancer-related HPV types) under control or get rid of it completely. However, if HPV infection does not go away over many years, there is a greater chance of developing cell changes that may lead to cervical cancer. Only very rarely does the presence of HPV lead to cervical cancer.


Can HPV infections be treated?

There is currently no treatment available for the virus itself. However, good treatments do exist for the diseases HPV can cause, such as cervical cell changes or genital warts. Your healthcare provider will discuss these treatment options with you, if you need them.


Should I have an HPV test?

Women 30 or older: In women 30 and over, screening using both an HPV test and a Pap test is more likely to find abnormal cervical cell changes than either test alone. If both tests are negative (normal), a woman may safely have her next Pap and HPV test in three years depending on her past Pap test findings and other risk factors. For this reason, some women now may have an HPV test when they have their Pap test. It will still be important to continue having routine recommended preventative health exams.

Women under age 30: Consensus guidelines do not currently recommend this. HPV is very common in women under the age of 30 and cervical cancer is very rare in this age group. Most women under 30 with HPV will get rid of the virus without treatment. So including an HPV test along with your Pap isn?t helpful for younger women and might be harmful if it resulted in too many tests and unnecessary treatment.

After age 30, HPV is much less common. If you are over the age of 30 and you test positive for HPV you may have gotten it many years before and your immune system hasn’t gotten rid of it. Because HPV must be present for many years to cause cell changes, testing for HPV after the age of 30 is much more helpful.

I am under age 30, but my doctor suggested HPV testing after my Pap came back as "ASC-US." Why?

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. If you have a follow-up HPV test after an ASC-US Pap result and the HPV test is negative, you probably do not need additional follow-up other than to repeat your Pap in one year. 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. This is different from using the HPV test with the Pap as part of your normal health visit.


What if the HPV test and Pap test are both normal?

If both the HPV test and the Pap test are normal you have very little risk of any worrisome changes occurring in your cervix over the next 3 years. You should discuss with your physician the optimal time for follow-up testing according to professional recommendations and the physician's assessment of your clinical history.


If I tested positive for HPV, what does this mean for me?

Most HPV infections go away without treatment because the immune system finds the virus and either gets rid of it or suppresses it to the point that it is unlikely to cause additional problems. Cell changes that may eventually lead to cervical cancer only occur when this does not happen and HPV stays for many years. Even though HPV is found in cervical cancer, most people testing positive for HPV are not at risk for getting cervical cancer because they have the virus for only a short time (months rather than many years). Therefore, women with a normal Pap who test positive for HPV will usually be tested for HPV again in 6-12 months. Testing positive a second time does not mean that there is great risk of cervical cancer, or even of cell changes that may lead to cervical cancer, but it does mean that further evaluation will likely be recommended.

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.


If I test positive for HPV, how did I get it?

HPV is usually acquired by direct skin-to-skin contact during intimate sexual contact with someone who is infected. Most men and women are not aware that they have the virus. Condoms do not offer complete protection from HPV. Increasing numbers of partners increases the risk of getting HPV, but the virus is so common that having only a single lifetime partner does not assure protection. It is usually impossible to determine when, and from whom, HPV was caught. HPV may be detected fairly soon after exposure, or may not be found until many years later. For all these reasons, it is not helpful, nor fair to blame your partner.


What does my positive HPV test mean for my partner?

Most sexually active couples share HPV until the immune response eliminates the infection. Partners who are sexually intimate only with each other are not likely to pass the same virus back and forth. When HPV infection goes away the immune system will remember that HPV type and keep a new infection of the same HPV type from occurring again. However, because there are many different types of HPV, becoming immune to one HPV type may not protect you from getting HPV again if exposed to another HPV type.


If I have HPV, is there anything I can do?

Don't smoke. Smoking has been shown to increase the chance that cell abnormalities might progress to more severe changes. Be sure to keep your follow-up doctor appointments.


What about partners?

Most sexually active couples share HPV until the immune response suppresses the infection. Partners who are sexually intimate only with each other are not likely to pass the same virus back and forth. When HPV infection goes away the immune system will remember that HPV type and keep a new infection of the same HPV type from occurring again. However, because there are many different types of HPV, becoming immune to one HPV type may not protect you from getting HPV again if exposed to another HPV type.


Will I have the HPV virus forever?

Probably not. HPV infection is very common, but it usually clears, or is suppressed by the immune system, within 1-2 years.

Key Points to Remember

Remember that 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.



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