Cervical cancer is a worldwide health concern, and early detection through screening is important for prevention. The screening process includes two important tests: the Pap smear and the HPV test. While both are essential and useful, they have different purposes.
Let’s check out these tests, their specific roles in cervical cancer screening, and how they can be used to improve women’s health. You may also schedule a consultation with a healthcare provider to make more informed decisions about your cervical health.
What is a Pap Smear?
A Pap smear involves collecting cells in the cervix to detect abnormal changes that may indicate cancer, precancerous conditions and other diseases related to the cervix. The test is crucial for early detection, as identifying these changes allows for timely intervention, significantly improving treatment outcomes.
What is an HPV Test?
An HPV test (human papillomavirus test) is a tool used to detect the presence of high-risk strains of the HPV virus, which are associated with cervical cancer. Unlike a Pap smear that focuses on cellular changes, the HPV test analyses the virus’s genetic material, providing a virological assessment. The HPV virus is the virus responsible for up to 98% of all cervical cancers.
The primary purpose of the HPV test is to identify the presence of the virus that could lead to cervical pre-cancer and cancer, enabling timely monitoring and intervention.
The Purpose of Pap Smear vs. HPV Test
Role in Cervical Cancer Screening
Pap smear and HPV test serve distinct yet complementary roles as cervical cancer screening. With a Pap smear, abnormal cervical cells that could potentially develop into cancer will be identified and treated early.
In contrast, the HPV test focuses on identifying high-risk strains of the HPV virus. This will help assess the patient’s risk of developing cervical cancer.
Differences in Focus
While a Pap smear can reveal changes caused by HPV infection, it does not identify the virus itself. The HPV test specifically assesses the presence of human papillomavirus, providing a more comprehensive understanding of cervical health risks.
Key Differences Between Pap Smears and HPV Tests
Understanding the distinctions between Pap smears and HPV tests will highlight the type of test that is suitable for you.
Age and Frequency Recommendations
- Pap smear. Recommended for individuals aged 21 to 65. The American College of Obstetricians and Gynecologists suggests that those aged 21 to 29 should have a Pap smear at least every three years. For those aged 30 to 65, it can be performed every three years alone or every five years when combined with an HPV test (co-testing).
- HPV test. Recommended for individuals aged 30 and above. The primary HPV test is advised every five years. If co-testing is performed with a Pap smear, it is also recommended every five years.
Sensitivity and Specificity
- Pap smear. Primarily detects abnormal cervical cells (dysplasia) that could lead to cancer if untreated. While it is effective in identifying precancerous changes, it has a lower sensitivity compared to HPV testing for detecting high-risk HPV strains.
- HPV test. It has a higher sensitivity for identifying potential risk factors of cervical cancer.
Cost Differences
- Pap smear. Generally less expensive than HPV tests. Its cost varies on healthcare providers and insurance coverage, but insurance plans often cover it as part of routine healthcare.
- HPV test. Typically more expensive than a Pap smear, particularly when performed as a standalone test.
When to Choose a Pap Smear or HPV Test
Both tests are recommended when you reach the age of 30 years old and above. However, individuals with a history of abnormal Pap results, those living with HIV, or individuals with weakened immune systems may require closer monitoring as they are at higher risk. Additionally, women who smoke or have multiple sexual partners may also face increased risk.
Co-testing can help identify precancerous changes and high-risk HPV strains simultaneously. This dual approach helps improve the accuracy of cervical cancer screening and allows for longer intervals between screenings – typically every five years – if both tests return negative results.
Testing Procedure Comparison
The procedures for a Pap smear and an HPV test are done in the same method and is often recommended to be done together at a go to reduce patient discomfort.
What Happens During a Pap Smear
- Preparation. The healthcare provider will ask the patient to undress from the waist down and lie on a table for examination.
- Speculum insertion. The healthcare provider gently inserts a speculum into the vagina to hold it open, allowing access to the cervix.
- Cell collection. The provider collects cells from the cervix using a small swab or brush. This may cause mild discomfort, which usually goes away after the procedure.
- Sample preservation. The collected cells are placed into a liquid medium or onto a slide for laboratory analysis.
- Post-procedure. The speculum is removed, and the patient can resume normal activities.
What Happens During an HPV Test
- Preparation. Like the Pap smear, the patient undresses from the waist down and lies on an examination table.
- Speculum insertion. A speculum will be inserted into the vagina to visualise the cervix.
- Cell collection. Cell samples are collected using a small brush or swab, either from the same sample used for the Pap test or as a separate sample. This process may also cause mild discomfort.
- Lab testing. The sample is sent to a lab where it is tested for HPV DNA to determine if any high-risk strains are present.
- Post-procedure. After the test, patients may experience light vaginal bleeding for a day or two but can return to normal activities.
Test Results and Follow-Up
After undergoing a Pap smear or HPV test, patients can expect to receive their results typically within a few weeks.
Pap Smear Results
Pap smear results can be categorised into several types:
- Normal (Negative). This indicates no abnormal cell changes were found, but regular screenings should continue as new changes can develop over time.
- Abnormal. This result suggests the presence of cell changes. Abnormal results can be classified as low-grade or high-grade. Abnormal pap smear results may require a referral to a specialist for a further checkup, called a colposcopy.
- Unclear (ASC-US). This result indicates that the cells appear atypical, but it is uncertain if they are related to HPV. Further testing with an HPV test may be recommended to clarify the situation.
HPV Test Results
HPV test results are generally reported as:
- Negative HPV Test. This result indicates a lower risk of developing cervical cancer, and follow-up screenings are typically recommended every five years.
- Positive HPV Test. Indicates the presence of one or more high-risk HPV types. A positive result does not mean cancer is present; rather, it signals an increased risk of developing precancerous changes in the cervix. Patients with positive results may require closer monitoring and additional testing.
Follow-Up After Abnormal Results
If either the Pap smear or HPV test yields abnormal results, further diagnostic procedures may be necessary:
- Colposcopy. It involves using a special magnifying instrument to closely examine the cervix for abnormalities.
- Biopsy. If abnormal cells are detected during colposcopy, a biopsy will help determine whether these cells are precancerous or cancerous. The biopsy results guide treatment decisions and follow-up care.
Pros and Cons of Pap Smear and HPV Test
A comparison between Pap smear and HPV test’s advantages and limitations helps women make informed decisions regarding their health. Here are some pros and cons of each test.
Advantages of Pap Smear
- Early detection. Pap smears are effective in identifying precancerous cells early.
- Widely available and cost-effective. Pap smears have been a standard practice for decades, making them widely accessible and generally less expensive than HPV testing.
Advantages of HPV Test
- High sensitivity. The HPV test has a higher sensitivity for detecting HPV strains associated with cervical cancer, making it more reliable in identifying individuals at risk.
- Better predictive value. HPV testing provides a clearer indication of cervical cancer risk.
Importance of Regular Cervical Screenings
Regular cervical screenings, like Pap smears and HPV tests, are essential for the prevention and early detection of cervical cancer. They will be able to identify precancerous changes and high-risk HPV strains before they develop into cancer, allowing for interventions that can potentially prevent disease progression.
Cervical cancer is largely preventable, and a study shows that consistent screening significantly reduces mortality rates. While no screening method is perfect, and false positives or negatives can occur, the benefits – such as improved survival rates and reduced treatment burdens – far outweigh these limitations.
Conclusion
Pap smears and HPV tests are essential in the early prevention of cervical cancer. While Pap smears have been a longstanding and cost-effective screening method, HPV tests provide additional information about the presence of high-risk HPV strains, offering better predictive value for cervical cancer risk-making them complementary.
Regular cervical screenings remain paramount in the fight against cervical cancer. Early detection can save lives, so prioritise regular cervical screenings and consult your healthcare provider for personalised guidance.
