HPV and Cervical Screening

In brief

Persistent infection with high risk types of HPV is the main cause of cervical cancer. Most HPV infections clear on their own and never cause disease. Screening finds the small proportion that persist and produce precancerous change, which can then be treated before cancer develops.

HPV is very common and infection is not in itself a diagnosis of anything serious. What matters is whether a high risk type persists over years.

What HPV Is

HPV, human papillomavirus, is a group of related viruses. Some types cause no disease, some cause warts, and a smaller group described as high risk can cause changes in cervical cells. Transmission is through skin to skin contact, most often sexual contact, and infection is common enough that it carries no implication about behaviour.

The immune system clears most infections without treatment and without symptoms. Cervical disease develops in the minority of cases where a high risk type persists, usually over a period of years, and that interval is what screening is designed to catch.

Screening Tests

  • HPV test. Checks cervical cells for infection with high risk HPV types.
  • Pap test. Checks cervical cells for changes caused by HPV that could develop into cancer.
  • Co-test. Both performed on the same sample.

Intervals in International Guidance

Guidance from the United States National Cancer Institute describes a first Pap test at 21 and then every three years to 29; from 30 to 65, an HPV test every five years, a co-test every five years, or a Pap test every three years. Updated American Cancer Society guidance describes starting at 25 with HPV testing every five years, with the other options remaining acceptable. Beyond 65, continuation is discussed individually and may not be needed after a history of normal results.

National programmes differ from country to country, and the interval that applies to you depends on your own history as much as on your age. Bring your previous results to your appointment so that the correct interval can be set.

Vaccination

HPV vaccination reduces the risk of infection with the types it covers. It does not cover every high risk type, and for that reason people who have a cervix are advised to continue screening even after vaccination.

An Abnormal Result

An abnormal screening result is not a diagnosis of cancer. It is a reason for a closer look, usually colposcopy, an examination of the cervix under magnification with a biopsy taken from any suspicious area. Most findings at this stage are precancerous changes that can be treated with a local procedure that preserves the uterus. Details are on the cervical cancer page.

For an assessment, see the contact page. This page is general information and does not replace an examination. Decisions about your own treatment can only be made after assessment.

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