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To Your Health: New Guidelines for Pap Tests and the HPV Vaccine

Last updated: Jan 29, 2019

As appears in: Montclair Local

Editor’s note: This series will be written by practitioners in Summit Medical Group (SMG) on health-related topics. This one is by Dr. Karen Dias-Martin, gynecologist at Summit Medical Group in Glen Ridge. Dr. Dias-Martin appears on the 2017 list of New Jersey’s Top Doctors. She has lived in Montclair for 30 years.

Most women are diligent about scheduling their yearly trip to the gyno—and it shows. In the past three decades, the number of women being diagnosed and dying from cervical cancer has dropped dramatically.

Like any cancer, early detection and prevention is key. The single most important thing a woman can do to stop cervical cancer before it starts is to have a regular Pap test. This screening tool can detect pre-cancerous changes inside the cervix before the cancer even develops.

Today, we know that 90 percent of all cervical cancers—and some vaginal, anal, head, and neck cancers—are caused by the human papillomavirus, more commonly known as HPV. Every year, nearly 14 million women and men in the U.S. are infected with HPV.

Recently, my patients have been asking about new guidelines for Pap testing and a vaccine called Gardasil-9 that protects against HPV. Here are some of their most common questions.

 

My friend’s gyno said to wait three years before her next Pap test. Do I really need one every year?

It is not necessary to test all women every year—it really depends on your risk for cervical cancer. In general, the guidelines now recommend a Pap test every three years for women ages 21 to 29; every five years (along with an HPV test) for women ages 30 to 65; and women over 65 years of age without a history of precancerous cervical changes do not need to be screened at all. Even if you are not due for a Pap test, you should still visit your gynecologist yearly.

 

Actually, if I am being honest…I may be high-risk. Now what?

Women who have a history of smoking, persistent HPV infection, multiple sexual partners, sexually transmitted diseases, or a weakened immune system are more likely to develop cervical cancer. These patients should have a yearly Pap test.

 

I am nervous for years to pass between Pap tests. What happens if cancer develops in that time?

Cervical cancer usually grows slowly and is self-contained. The prognosis is unlikely to change in three years. If you have an abnormal Pap test, the initial testing and biopsy can be done in my office. For advanced cases, the gynecologic oncologists at Summit Medical Group  are highly successful in using immunotherapy to destroy cancer cells.

 

I thought Gardasil was just for 20-somethings. I am 35 years old and have a history of HPV infection. Can I get the vaccine?

Gardasil is a two-series shot that used to be recommended for men and women between the ages of 11 and 26. However, the Food and Drug Administration now says the vaccine may be beneficial up to age 46. It is important to talk to your insurance company first because they may not pay for the vaccine.

My teenage daughter is sexually active. The pediatrician says she needs Gardasil. Can I bring her in for an exam?

If your child is coming in for contraception then it is time to have the HPV vaccine. Pediatricians often recommend boys and girls get the vaccine at age 11 or 12. It is important to come in for a checkup and be tested for sexually transmitted diseases, however we do not start Pap testing until age 21. Cervical cancer is generally diagnosed between ages 35 and 44 so the risk of a teenager developing the disease is extremely low.

 

I tested positive for HPV, but my Pap test was normal. What does that mean?

Similar to chickenpox, lots of people have inactive HPV that lays dormant in their body. HPV is only medically important if your Pap test is abnormal. For these patients, it would be important to have a yearly Pap test to detect any changes.

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