Some can wave goodbye to annual pelvic exams and Pap tests
Researchers know that cervical cancer usually takes 15-20 years to develop. This knowledge made the clinical community question whether women need to have a Pap test (cervical cancer screening) and pelvic exam every single year. That, combined with the 2024 approval by the Food and Drug Administration (FDA) of an HPV test with specimen self-collection, changed everything. Women are now finding themselves looking at a new gynecologic landscape.
While a cervical cancer screening gathers cells from the cervix and tests them, the human papillomavirus (HPV) test looks for types of HPV that are most likely to cause cancer. The Centers for Disease Control and Prevention reports that more than nine of every 10 cases of cervical cancer are caused by HPV. So, cervical cancer screening is essential, but not every year.
“Women no longer need an annual cervical cancer screening,” says obstetrician gynecologist (OB-GYN) Emily Brophy, MD, with LVPG Obstetrics and Gynecology.
Traditionally, the screening is performed by way of an unpopular pelvic exam. Cell samples are taken while women lie with their feet in stirrups and a metal speculum holds the vagina open. Other than facilitating the screening, pelvic exams are not necessary unless there is a problem.
“There is a misconception that pelvic exams can pick up ovarian cancer. That’s not the case, as there is no good test for ovarian cancer,” Dr. Brophy says. “The new thinking is that symptoms should be the guide for conducting the pelvic exam. There now must be an additional reason, such as a pelvic pain, abnormal bleeding or vaginal discharge.”
Falling in line with this revised approach is the introduction of an HPV test with specimen self-collection. Lehigh Valley Health Network (LVHN) and HNL Lab Medicine have made the test available in the Lehigh Valley, and it’s an alternative that practically eliminates the unwanted pelvic exam. “It’s part of evolving with the times and also making things more comfortable for our patients,” Dr. Brophy says.
The new method and testing product offered by LVHN looks like a long cotton swab. The swab is inserted into the vagina and rotated a couple of times to take a sample. The sample is then sent to a lab for HPV testing with an approved test.
The decision to go with specimen self-collection should be made together with a clinician, so the patient’s personal history can be taken into consideration. “Women can always choose to have a Pap smear test,” Dr. Brophy says, and points out the self-test is not for everyone. “If you’re currently experiencing symptoms, have a weakened immune system or a history of abnormal cervical screenings, talk to your clinician. A clinician-collected test may be more appropriate for you.”
A home test is being evaluated in California and may be available in more states soon. For now, in Pennsylvania, self-collection is done in primary care and OB-GYN offices. Women will need an appointment to conduct the test. If the test comes back positive, additional tests – such as a cervical cancer screening or diagnostic test called a colposcopy – will be needed to see if the virus has caused any changes in the cervix that might progress to cancer.
Understanding it takes years for cervical cancer to develop, the U.S. Preventive Services Task Force updated its guidelines to:
Dr. Brophy explains the distinction by age. “Most women will get HPV at some point in their lifetime,” she says. “Young women between the ages of 21 and 29 can generally clear the virus on their own. For women over 30 it’s more difficult, so testing during the later age range is more stringent.”
While the cervical cancer screening may not need to be done every year, Dr. Brophy recommends women not give up their annual visit to the gynecologist. “The visit is still important,” she says. “It’s an opportunity to discuss urinary or bowel issues, sexual health, birth control, breast concerns, perimenopause and all the other aspects of well-woman care.”
