HPV Testing and Cervical Screening
HPV testing is not automatically included in a standard cervical smear (Pap test), but it depends on the patient's age and the specific screening strategy chosen. For women aged 21-29 years, screening consists of Pap test alone every 3 years without HPV testing, while for women aged 30-65 years, co-testing (Pap test plus HPV DNA test) every 5 years is the preferred approach 1, 2.
Age-Specific Screening Strategies
Women Aged 21-29 Years
- Pap test alone every 3 years is recommended without HPV testing 2
- HPV testing should not be used for screening or management of abnormal Pap tests in women under age 21 years 1
- The rationale is that HPV infection is extremely common and usually transient in this age group, leading to high false-positive rates that result in unnecessary colposcopies and treatments 1, 3
Women Aged 30-65 Years
- Co-testing (Pap test plus HPV DNA test) every 5 years is the preferred screening approach 1, 2
- Alternatively, Pap test alone every 3 years is acceptable if co-testing is not available 1
- Women who are negative on both HPV and Pap testing can safely extend screening intervals to 5 years 1
- A single negative HPV test provides sufficient reassurance against cervical cancer over 5 years, with a 5-year cumulative cancer incidence of only 3.8 per 100,000 women 4
Clinical Uses of HPV Testing
Primary Screening (Age ≥30)
- HPV testing can be used in conjunction with Pap testing (co-testing) for routine cervical cancer screening 1
- HPV testing should never be used as a stand-alone test without cytology 1
- Co-testing identifies 35% of high-grade lesions and 29% of cancers in women who have normal cytology but are HPV-positive 4
Triage of Abnormal Results
- HPV testing is recommended for triaging women aged ≥21 years with ASC-US (atypical squamous cells of undetermined significance) cytology results 1, 2
- This use is distinct from primary screening and helps determine which women with equivocal Pap results need colposcopy 1
Important Caveats
What HPV Testing Is NOT Used For
HPV DNA testing is not recommended for 1:
- Deciding whether to vaccinate for HPV
- STD screening purposes
- Testing adolescents aged <21 years
- Primary cervical cancer screening as a stand-alone test without Pap testing
Special Populations
- Women who have received HPV vaccination should be screened using the same recommendations as unvaccinated women 1, 2
- Pregnant women should follow the same screening recommendations as non-pregnant women 2
Practical Implementation
When ordering cervical cancer screening, clinicians must specify whether they want:
- Pap test only (appropriate for ages 21-29, or ages 30-65 if done every 3 years) 1, 2
- Co-testing with Pap plus HPV (preferred for ages 30-65 if screening every 5 years) 1, 2
The key distinction is that HPV testing is an optional add-on for women aged 30 and older, not an automatic component of every cervical smear 1. The same cervical sample collected for liquid-based cytology can be used for HPV testing, making co-testing logistically straightforward 1, 5.