HPV, Cervical Cancer & Pap Smears… What is the connection?
- Shannon Leach, MSN, ARNP
- 2 days ago
- 10 min read
Approximately 1 in 150 (0.6%) women will be diagnosed with cervical cancer, caused by long-lasting Human Papilloma Virus (HPV) infection.
But, thankfully, this number is relatively low due to our ability to prevent, screen, and treat it.
Cancer is always a scary word, but the more we educate ourselves about specific cancer types, the better we are able to try to prevent cancer, detect it early, and get treatment.
In this article, we'll answer common questions about cervical cancer, HPV & Pap smears, including:
What Is the Human Papilloma Virus (HPV)?
HPV refers to a group of viruses spread during skin-to-skin contact, mostly during sex . It is the most common viral STI in the United States, and approximately 14 million people get infected each year.
HPV can affect various parts of your body. There are over 100 types of HPV – some causing warts on your hands, feet, and face. Approximately 30 HPV strains, though, can affect your genitals, including the type of HPV causing genital warts.
What causes cervical cancer?
Simply Put: Some strains of HPV are high-risk and can lead to cancers, including cervical and vaginal cancers.
Cervical cancer starts in the cells of the cervix (the lower, narrow part of the uterus connecting to the vagina). It begins when the cells of the cervix start to undergo changes that cause abnormal cells to appear. Over time, if those abnormal cells are not treated or removed, they may become cancerous cells that can spread more deeply into the cervix or other surrounding areas.
There are known to be 14 HPV strains that are considered high risk for cervical cancer. Approximately 70% of all cervical cancers are caused by HPV strains 16 & 18, and certain strains of high-risk HPV cause changes in the cells of your cervix, ultimately leading to cervical cancer.
Common Risk Factors for Cervical Cancer Include:
Risk Factor #1: HPV infection
As previously explained, 70% of all cervical cancers are caused by 2 strains of HPV!
Risk Factor #2: Sexual activity
Anyone who has been sexually active is at risk for HPV infection. HPV is spread through skin-to-skin contact. This can occur through:
Oral sex
Touching in the genital area
Vaginal sex
Anal sex
Sharing sex toys
Additionally, having sex at a young age and/or having multiple partners increases the number of potential exposures to HPV.
Risk Factor #3: Smoking
Toxic tobacco chemicals are delivered to the cervix and can collect in the mucus of the cervix, break down/alter DNA inside cervical cells, and cause gene mutations. Smoking also weakens the body’s immune system, as it helps HPV to stay active longer and can damage cell DNA which can cause gene mutations–turning normal cells into cancerous cells.
Risk Factor #4: Birth control pills
Taking oral contraceptives for five or more years slightly raises the risk for cervical cancer.
Risk Factor #5: Other infections / immune-lowering medications
Weakened immune systems, other infections, and conditions like HIV or immune-lowering medications can prevent the body from fighting off the HPV infection. Additionally, a history of sexually transmitted infections such as chlamydia, gonorrhea, or others adds to your risk for cervical cancer.
How can I test for HPV and cervical cancer?
Testing for high-risk HPV and cervical cancer requires testing your cervical or vaginal cells. This typically is done using a clinician-collected exam (such as the Pap smear and HPV test). HPV testing can also be done by performing a self- vaginal swab with an FDA-approved test, although this at-home test is not the same as a traditional Pap smear. The cervical/vaginal sample is then sent to a lab to identify whether HPV is present and if there are any cell changes from the collection site. Cascade Women's Health performs Pap Smears and HPV testing for free as part of our Well-Woman Exam!
The HPV test specifically looks for high-risk strains that have been known to cause cellular changes and subsequently, cancer.
The Pap Smear specifically looks for abnormal or precancerous cell changes on the cervix itself.
I’ve never had a Pap smear. When should I get my first one?
Pap smear testing should begin at the age of 21 regardless of whether you are sexually active. Pap smears are not recommended prior to age 21, even if you are sexually active.
However, if you have concerns about vaginal symptoms, sexually transmitted infections, pelvic pain or other symptoms, it is importance to discuss these with a healthcare professional regardless of age.
How often do I need to test for HPV / Cervical cancer?
HPV testing is not routinely done until the age of 30.
Age 21-29
It is recommended you screen for cervical cancer (with a Pap smear) every three years if your Pap smear is normal. However, if you have an abnormal Pap smear, HPV testing may be added to determine the recommended frequency of follow-up testing.
Age 30+
Beginning at age 30, HPV testing is often done at the same time as your Pap smear. If both your tests are normal, repeat testing is recommended every five years.
If you are over 30 and your Pap and/or HPV are abnormal, subsequent testing and/or procedures may be recommended. More frequent testing may be advised, too.
Age 65+
Pap smears are no longer recommended after the age of 65 if you have a history of normal Pap smear and HPV tests.
Will I have symptoms if I have HPV or cervical cancer?
Early-stage cervical cancer and HPV often do NOT have any symptoms. Symptoms typically appear only when the cancer has progressed to later stages and tissue has spread to other areas. Regular screenings with the Pap Smear/HPV testing are critical, as these tests can find cellular changes well before symptoms begin.
If symptoms are related to cervical cancer, they might include:
Vaginal bleeding after intercourse, between periods or after menopause
Menstrual bleeding that is heavier or longer than normal
Watery, bloody vaginal discharge that is heavy with or without an odor
Pelvic pain
Pain during intercourse
As always, if you have any concerning symptoms, it is important to follow-up with a health care professional for further evaluation.
How can I prevent HPV / cervical cancer?
Prevention Strategy #1
HPV is largely preventable through regular screening and HPV vaccinations, which offer the best protection against high-risk HPV strains that cause cancer and genital warts. The HPV vaccine is routinely recommended for preteens ages 11 or 12, but can be started as early as age 9. Catch-up vaccination is recommended by National Cancer Institute for everyone through the age of 26. For those ages 27-45, vaccination recommendation is based on risk factors and should be discussed with a medical clinician to determine if it is appropriate.
Prevention Strategy #2
If you smoke or vape, quitting will decrease your risk for HPV / cervical cancer.
Prevention Strategy #3
If you are sexually active, condom use can help decrease your risk for HPV. Consistent condom use lowers transmission of HPV, but be cautious, as condoms do not cover all skin areas.
Prevention Strategy #4
We recommend full STI testing with every new partner to lower your HPV risk. While early treatment does not directly prevent or decrease the biological risk of contracting HPV, it will help to reduce tissue inflammation and immune stress, allow your body to more effectively clear HPV, and ultimately help to avoid cellular damage. Less inflammation and stronger immunity help lower the chance of HPV infection sticking around.
What is the treatment for HPV and/or cervical cancer?
There is no cure or direct medical treatment for HPV, but there are treatments for abnormal cells found on Pap smears and genital warts, both of which are caused by the HPV virus.
There will be times when the HPV test is positive and the recommendation will simply be to screen for HPV and cervical cancer more frequently—perhaps in one year, for example, rather than three).
It is possible for HPV to clear on its own and often does within one to two years, especially for those under the age of 30. However, if it does not clear on its own and the HPV infection causes abnormal cellular changes on the cervix, further intervention will likely be recommended.
Abnormal Pap smears with or without positive HPV may also result in more frequent testing and/or further intervention and treatment.
Treatment options for abnormal Pap smears include:
Treatment Option #1: Colposcopy
A colposcopy is a procedure that can check for precancerous or cancerous cells on your cervix. A trained professional will use a medical device called a “colposcope,” which works like a microscope with a bright light to more closely evaluate the cervix. While the cervix is the main focus, it can also assess the vagina and vulva. If your provider finds any abnormalities, they may take a small biopsy (removal of a piece of tissue) of the abnormal-appearing tissue and send it to a lab for further evaluation.
Treatment Option #2: Loop Electrosurgical Excision Procedure (LEEP) procedure
A LEEP is a medical treatment that uses a thin wire loop heated by an electric current to remove abnormal cells and tissues from the cervix, so as to diagnose and treat cervical cell abnormalities present on the cervix. They can also use this procedure to help diagnose or manage conditions such as cervical polyps or genital warts. The tissue layer removed during this procedure is sent to the lab to evaluate more extensively for abnormalities and/or cancer.
Treatment Option #3: Cryotherapy
Cryotherapy freezes and destroys abnormal surface cells on the cervix using a cold metal probe with compressed gas. This is done by a trained medical professional. The main goal is to destroy mild precancerous tissue so that healthy cells can grow back. Because the cell tissue is destroyed, there is no tissue available to send to a lab for further testing.
Treatment Option #4: Cone Biopsy (Conization)
A surgeon uses a scalpel, laser, or specialized wire loop to cut out a deep, cone-shaped piece of tissue from the cervix. The main goal is to diagnose deeper problems or remove deeper abnormal cells that surface treatments cannot reach. This is typically done in the operating room under general or regional anesthesia.
Treatment Option #5: Surgery & More
Those diagnosed with cervical cancer may require more extensive and invasive treatment, including surgery (hysterectomy as an example), radiation therapy, chemotherapy, immunotherapy, and/or targeted therapy.
What Happens If HPV Is Left Untreated?
Untreated HPV may increase the risk of cervical cancer. That is why it is critical that you stay up-to-date on your cervical cancer screenings by getting Pap smears and HPV testing done on a routine basis. You can receive both through a free Well-Woman Exam at Cascade Women's Health, request an appointment today!
When Should You See a Healthcare Provider?
Regular Pap smears and/or HPV testing should be done at regular intervals, according to the schedule above. Please discuss your schedule with your healthcare provider.
Additionally, it is important you schedule an appointment if you experience abnormal symptoms such as:
Vaginal bleeding after intercourse, between periods, or after menopause
Menstrual bleeding that is heavier or longer than normal
Watery, bloody vaginal discharge that is heavy with or without an odor
Pelvic pain
Pain during intercourse
Vaginal symptoms – Discharge, itching, odor
Pain with urination, blood in the urine, going more frequently/urgently to the bathroom
Getting an accurate diagnosis is important because several conditions may cause similar symptoms, but require different treatments. Not all of these will be related to HPV or Cervical Cancer, but it is important to test for other infections, too.
Frequently Asked Questions
I have HPV. Will I always have HPV?
Your immune system usually clears or suppresses the virus within 2 years.
If you’re under the age of 30, our bodies do a REALLY good job of clearing HPV infections on their own. However, if your Pap smear is also abnormal, further testing and/or more frequent follow-ups may be recommended. Please discuss this with your healthcare profession.
If you’re over the age of 30 and HPV is present, you will likely need further testing and more frequent follow-up.
If HPV persists over many years, it is considered a persistent infection that can lead to abnormal cell changes.
I have HPV and/or an abnormal Pap smear. Am I guaranteed to get cervical cancer?
Absolutely NOT! It is important to remember that just because you have HPV or an abnormal Pap smear, this does NOT mean you’ll get cancer.
How does HPV spread?
Skin-to-skin contact – HPV spreads through sexual activity. Condoms can help lower the risk, but condoms cannot completely prevent HPV as HPV can live on skin not covered by a condom.
I am sexually active but am not yet 21. Should I have a Pap smear or be tested for HPV?
Pap smears are generally not recommended until age 21, and HPV testing typically begins at age 30, unless there is a history of abnormal Pap smear. However, it is extremely important that you test for sexually transmitted infections with every new partner! If this is something you think you need, you can schedule a FREE STI Testing appointment with Cascade Women's Health now!
I am not sexually active and am over the age of 21. Do I still need a Pap smear?
Yes! The Center for Disease Control (CDC) recommends that all women, regardless of sexual activity, begin Pap smears at regular intervals beginning at the age of 21.
Does a Pap smear check for other sexually transmitted infections?
No, a Pap smear does not look for other sexually transmitted infections. But at Cascade Women's Health you can add other STI testing to your Well-Woman Exam for free!
Bottom line:
Schedule your Pap smear at the age of 21.
If your Pap smears are normal (ages 21-29), continue scheduling and completing your Pap smear every three years.
Begin testing for HPV at age 30. This will often be done at the same time as your Pap smear.
If your Pap smear and HPV testing are normal (ages 30-64), continue scheduling and completing your Pap and HPV testing every 5 years.
If you have an abnormal Pap smear and / or positive HPV test, follow the recommended screening interval as directed by your healthcare professional!
Are you due for a Pap smear for cervical cancer screening? We’d love to help you get a free exam scheduled at Cascade Women's Health!
If you are 21-29 we will offer a Pap smear. HPV testing will only occur if your Pap smear is abnormal.
If you are 30-64, we will perform a Pap smear and test for HPV.
We also offer STI testing – As mentioned above, it is important to identify STIs early and treat them early to keep your immune system as strong as possible and limit inflammation. Schedule your STI testing today!
Resources:
Important Note: The information provided in this article is for educational purposes only. While it was written by a licensed healthcare professional, it is not a substitute for personalized medical advice, diagnosis, or treatment. If you have questions about your health, please schedule an appointment with a healthcare provider who can evaluate your individual needs.
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