The New HPV Test You Should Ask Your Doctor About
What if your Pap is fine, but your HPV test is positive?
First, it doesn't mean that you definitely have cancer or will get cancer. But what's next depends on whom you ask. Some experts recommend, if possible, following up with the more specific HPV 16/18 test, approved last year, to check if the two most worrisome forms of the virus are present (this test is not yet widely available). If that test is positive, your doctor will almost certainly advise a colposcopy, a procedure in which the cervix is viewed directly through a tube-like microscope and, if necessary, tissue samples are removed. But most experts advise retesting in a year and, if those tests are positive, then doing a colposcopy, says Karen Smith-McCune, M.D., associate professor of obstetrics and gynecology at the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center. However, not all women are comfortable with this wait-and-see approach. "I am getting a lot of self-referrals from women who are really frightened because they tested positive for HPV and don't want to wait even a few weeks for additional test results," says Dr. Smith-McCune.
What about the other way around — your HPV test comes back clear, but your Pap is questionable?
The standard advice — come back for an additional set of tests in a year — may not be what a worried woman wants to hear, but it's the overwhelming consensus among experts. Most mild abnormalities will clear on their own; also, there are guidelines to help doctors decide which cell changes need further examining with a colposcopy and biopsy. "The majority of women who die from cervical cancer in the U.S. either have never been screened or haven't been screened in five years or more," says Dr. Saslow.
Should you ask your doctor about the test?
Absolutely, says Dr. Diaz-Arrastia. You may think, 'How could I have HPV?' but in a study she supervised at the University of Texas Medical Branch at Galveston, researchers found there was a peak in active infections in women in their 50s. In one group of 167 women age 55 and over, 35 percent of those who tested positive for active HPV reported no sexual activity for five or more years. These women may have had persistent or recurrent infections; she speculates that the virus can reemerge, similar to the way shingles develops decades after a childhood bout of chicken pox.
Cervical cancer screening is in transition, from the Pap-only mode to the HPV/Pap testing combo and perhaps to HPV testing alone first, says Dr. Schiffman. Or the move may be to other techniques in development.
Meanwhile, the best way to safeguard your own health is to speak up: Ask about the new test, be open and honest about your sexual and medical history, and, if your doctor is hesitant, find out why. Habit is not a good enough reason to miss out on the reassurance that HPV testing can offer.