Common Tests Recommended in Conjunction with Pap Tests
HPV DNA testing is the most important complementary test to perform alongside Pap tests, particularly for women aged 30 years and older, where co-testing is the preferred screening approach. 1
HPV DNA Testing Recommendations
- For women aged 30-65 years, the preferred screening approach is co-testing with both HPV test and Pap test every 5 years 1, 2
- Women aged 21-29 years should have Pap tests alone every 3 years without HPV testing 1, 2
- HPV testing is recommended for the triage of women aged ≥21 years who have ASC-US (atypical squamous cells of undetermined significance) cytology results 1, 3
- Women who test negative on both HPV and Pap tests do not need to be re-tested for 3 years, providing greater reassurance than Pap testing alone 1, 4
Benefits of HPV Co-Testing
- Co-testing provides higher sensitivity (96-100%) for detection of cervical intraepithelial neoplasia (CIN) 2/3 and cancer than Pap testing alone 3, 5
- A single negative HPV test provides sufficient reassurance against cervical cancer over 5 years 4
- Co-testing allows for earlier identification of women at high risk of cervical cancer, especially adenocarcinoma 4
- For women aged 30 years and older with normal cytology and negative HPV results, the extended screening interval (every 5 years) is safe and effective 6, 4
Important Limitations and Contraindications
- HPV DNA testing is NOT recommended for the following situations 1:
- Deciding whether to vaccinate for HPV
- Conducting STD screening for HPV
- Testing adolescents aged <21 years
- Screening for primary cervical cancer as a stand-alone test (without a Pap test) in most settings
Documentation and Patient Education
- Providers should document whether a Pap test was obtained during the clinic visit and provide patients with a copy of their test results 1, 2
- Healthcare providers should discuss with patients 1, 2:
- The purpose and importance of Pap testing
- The need for regularly scheduled Pap tests
- Whether a Pap test will be obtained during the current visit
- Names of local providers or referral clinics if a Pap test will not be performed
Special Considerations for High-Risk Populations
- More frequent screening should be considered for HIV-infected women, women with previous abnormal Pap smears, after treatment for cervical dysplasia, and women with HPV infection 1
- Women who have had a hysterectomy with removal of the cervix and no history of high-grade precancerous lesions should not undergo routine screening 1, 6
- Women over 65 years with adequate prior normal screening can discontinue screening 2, 6
Common Pitfalls to Avoid
- Failure to adequately sample the transformation zone, resulting in unsatisfactory specimens 2
- Over-screening women under 21 years or more frequently than recommended intervals 2
- Inappropriate use of HPV testing in women under 30 years for primary screening 1, 2
- Many physicians still recommend more frequent screening than guidelines suggest, even when co-testing is performed 7
By implementing appropriate co-testing strategies and following evidence-based guidelines, providers can maximize the benefits of cervical cancer screening while minimizing unnecessary procedures and patient anxiety.