Guidelines for HPV Testing

Several medical organizations have issued guidelines for cervical cancer screening that include HPV testing. These include:

American Journal of Obstetrics & Gynecology

Specific guidelines governing what to do when a woman is found to have HPV were published in the October 2007 issue of the American Journal of Obstetrics & Gynecology. They were developed by 146 experts representing 29 organizations and professional societies.

Summary:

  • HPV testing is the preferred method of follow-up evaluation for women age 20-30 with inconclusive ("ASC-US") Pap results. If testing shows they do not have HPV, a repeat Pap is recommended in 12 months. If HPV is present, a colposcopy exam should be done.
  • Routine HPV testing, along with the Pap, is beneficial for women 30 and older.
  • Depending on the results from these tests, the next steps outlined below are recommended for women age 30+:

Normal PapInconclusive PapAbnormal Pap
Do not have HPV Repeat screening with both the HPV and Pap tests every three years. Repeat Pap test in 12 months. Have a colposcopy exam.
Have HPV Repeat both the HPV and Pap tests in 12 months. If either test is abnormal at that time, have a colposcopy (a procedure in which the cervix is examined using a lighted magnifying device, often accompanied by the removal of tissue for analysis). Have a colposcopy exam. Have a colposcopy.

 



Centers for Disease Control and Prevention (CDC)

In April 2007, the CDC published a brochure titled "HPV Information for Clinicians." It offers these guidelines: 

  • Girls and young women: The Advisory Committee on Immunization Practices recommends that the HPV vaccine be given to girls and young women age 11-26, but states that it can be given to girls as young as 9.

    Ideally, the vaccine should be given before a girl becomes sexually active, and thus exposed to HPV. If given afterwards, the vaccine will only protect her against the HPV type(s) to which she has not yet been exposed.

    In any case, even after vaccination, screening for cervical cancer risk (see the next point) is still needed, since the protection offered by the HPV vaccine is incomplete. 
  • Women of all ages: Regular Pap testing should begin three years after a young woman has sexual intercourse for the first time, or at the age of 21 – whichever comes first. The CDC recognizes that several leading medical organizations – including the American College of Obstetricians and Gynecologists, the American Cancer Society, and the American Society for Colposcopy and Cervical Pathology – endorse the use of HPV testing along with the Pap for women age 30 and over.


American College of Obstetricians and Gynecologists (ACOG)

Highlights from the ACOG 2005 Practice Bulletin on the Human Papillomavirus:

Recommendations based on "good and consistent scientific evidence":

  • HPV testing has been found to be more sensitive than the Pap in detecting pre-cancerous cervical cells (CIN 2 and 3). Thus, women who have a normal Pap and do not have HPV can be reassured that their risk of unidentified cervical cancer or pre-cancerous conditions is approximately one in 1,000.
  • Studies that combine HPV testing with the Pap have reported a "negative predictive value" (ability to say you are not at risk) for CIN 2 and 3 of 99-100 percent.

Recommendations based on "limited or inconsistent scientific evidence", but still considered good medicine:

  • Condom use may reduce the risk of HPV-related disease and may be effective in helping the body neutralize HPV infections.
  • Use of a combination of Pap and HPV screening is appropriate for women age 30 and older. If this combination approach is used, women who have normal results on both tests should be re-screened no more often than every three years.

Recommendations based primarily on "consensus and expert opinion" (rather than scientific data):

  • Women who are age 30 or older who have a normal Pap but who are found to have a high-risk HPV infection should repeat both the HPV and Pap tests in six to 12 months. [Note that more recent guidelines issued by the American Society for Colposcopy and Cervical Pathology recommend re-testing after 12 months.] If testing shows that a woman still has a high-risk HPV infection, she should have a colposcopy exam, regardless of the Pap result.
  • HPV testing can be used to determine whether treatment is working for women receiving treatment for pre-cancerous cervical cells (CIN 2 and 3).

Highlights from the ACOG 2003 Practice Bulletin on Cervical Cytology (Pap) Screening: 

  • Annual screening with a Pap test should begin approximately three years after a woman has participated in sexual intercourse for the first time, or at the age of 21 – whichever comes first.
  • Until the age of 30, women should have a Pap test every year. 
  • Once a woman reaches age 30, it is appropriate for her to have the test for the human papillomavirus (HPV) at the same time as the Pap. 
  • Women whose HPV test is negative and whose Pap smear is normal do not need to be re-tested for three years. (Women who get just the Pap need to be tested more frequently.) 
  • Cervical cancer screening is not necessary in a woman who has had a total hysterectomy, including removal of her cervix, if it was performed for reasons other than cancer and if she has no history of cervical disease. (Note that once the cervix has been removed, cervical cancer obviously is no longer a concern. Instead, doctors may do a "swab" and HPV test to look for abnormal cells in the vagina and vulva, since women with a history of cervical cancer may be at greater risk of cancer in those parts of the body. However, the ACOG guidelines also state that some data support stopping cancer screening in women who have had a total hysterectomy for any reason, once three Pap tests in a row have produced normal results.)