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What’s the difference between an HPV test and a Pap smear?

All HOMED-IQ content is reviewed by medical specialists

How does a pap smear work?

Pap smears are the most common screening method for cervical cancer and have been in use for decades. A Pap smear involves collecting a sample of cells from the cervix and checking them for changes that may develop into cancer. This sample is collected during a pelvic exam in a doctor’s office. Pap smears do not detect HPV itself, but rather cell changes in the cervix.

How does an HPV test work?

Unlike a Pap smear, HPV tests detect cervical HPV infections and not cell changes or cancer (NIH, 2022). These tests check for high-risk forms of HPV that are linked to cancer, and not other low-risk HPV types that cause genital warts. HPV tests can be performed during a pelvic exam, often at the same time as a Pap smear. However, it is also possible to perform a HPV test outside of a pelvic exam, in which an individual takes a vaginal swab and submits the sample for analysis. This swab test can be performed both in a doctor’s office and at home. Homed-IQ’s HPV Test for Women is a self-swab test that can be performed from home. This method of testing is also used by the Dutch Government for those uncomfortable performing a swab test with a doctor. However, if HPV is detected during this test, an additional Pap smear must always be performed by a doctor (RIVM, 2022). 

Which test is best at detecting cervical cancer?

While HPV tests can detect infections with HPV types that can cause cancer, they cannot detect precancerous or cancerous changes to the cervix. This is why all positive high-risk HPV tests should be followed up with a Pap smear. However, new research suggests that HPV testing may be superior to Pap smears alone in preventing cervical cancer, as HPV testing checks for the cause of cell changes (HPV) before these changes occur (Gage et al., 2014). Additionally, HPV testing results are more clearly interpretable as either positive or negative, while Pap smears require a visual inspection of the cells by a pathologist- a process that may be more prone to error. More research is needed in this area to conclude which screening method is the most effective in cervical cancer prevention.

In recent years, screening for high-risk HPV replaced Pap smears as the first-line population screening for cervical cancer in the Netherlands (Radboud UMC, 2020). Under the current guidelines, if an individual tests positive for high-risk HPV, the same cervical sample is then checked for cell changes or in the case of a self-test, a Pap smear is scheduled.

How often should you get a pap smear?

The starting age and frequency of cervical cancer screening depends on the guidelines of the country that you live in. In the Netherlands, screening begins at age 30 and occurs every 5 years (RIVM, 2022). In Germany, Pap smears are available annually from age 20. Women over 35 are offered HPV testing and a Pap smear every 3 years (Robert Koch Institute, 2022). Testing guidelines often vary by country due to the differing research on the benefits and drawbacks of screening. Although testing more often and starting at a younger age may detect more cases of cervical cancer, it can also result in unnecessary treatment and burden on individuals as many HPV infections or cell changes do not become cancer, and most high-risk HPV infections in young people clear themselves without any treatment (Radboud UMC, 2022). However, some individuals may also need to be screened more often or earlier depending on personal factors or the results of past HPV tests/Pap smears. Please speak to your doctor about what is appropriate for you, and do not hesitate to seek care if you are experiencing symptoms outside the screening age group. Furthermore, if you choose to perform a self-test for HPV, please be sure to read the section “Who should use this test” before making a decision.

Are there alternatives to a Pap smear?

Some women may be uncomfortable receiving a Pap smear in a doctor’s office for a variety of reasons. While a Pap smear is required to confirm cervical cell changes, screening for high-risk HPV before a Pap test can allow women to avoid the more invasive Pap test if they test negative for high-risk HPV. While many high-risk HPV tests are also performed by doctors, it is also possible to perform a self-sampling test. Self-sampling tests allow women who may be unable to access traditional screening methods to engage in care and potentially have better health outcomes than if they avoided screening completely. While not yet approved, potential future HPV screening methods include urine and menstrual blood tests.

How often should you get a HPV test?

Like pap smears, HPV testing frequency depends on the guidelines of the country you live in. While HPV has become the primary method of cervical cancer screening in the Netherlands, it is only used in specific groups in Germany. If HPV testing is not available to you via national screening programs, you may consider performing a home HPV test such as what Homed-IQ offers.

What happens if my HPV test is positive?

If your HPV test is positive for high-risk HPV, a Pap smear is needed to check for cell changes in the cervix. If you performed this test during a pelvic exam, the sample may be automatically tested for high-risk HPV if it is positive. If you performed a home self-test, you will need to schedule a Pap smear with your doctor. A positive HPV test does not mean you have cancer; however, it is important to follow up with your doctor to ensure cancer can be ruled out or additional treatment can begin.

Tip: also read our article “Understanding HPV and cancer”.

What happens if my pap smear is abnormal?

If your pap smear shows abnormal cells, your GP will likely refer you to a gynecologist for additional treatment. Again, this does not mean that you have cancer, but more investigation is needed. Next steps can include more frequent follow-up Pap smears or a  colposcopy, a procedure similar to a Pap smear in which a doctor examines the cervix with a magnifying lens and in some cases, takes a tissue sample for additional testing (Johns Hopkins Medicine, 2022). 

Testing for HPV from home 

HPV testing and Pap smears are valuable tools for catching cervical cancer before it occurs or in early stages, improving the prognosis or preventing it altogether. With Homed-IQ, you can monitor your cervical health from the comfort and privacy of home, whenever you would like to do it. This preventive health test checks for the two most high-risk forms of HPV (types 16 and 18) as well as 12 other high-risk types. Simply collect your sample from home and mail it to one of our certified laboratories for analysis. You will receive a laboratory report that can be brought to your doctor for follow-up care in care the result is positive.  

References

Choi, Y. S., Jin, H., & Lee, K. E. (2019). Usefulness analysis of urine samples for early screening of human papilloma virus infection. Journal of Cancer Prevention, 24(4), 240–244. https://doi.org/10.15430/jcp.2019.24.4.240

Fennell, J. S. C. (2021, November 10). My pap test was abnormal: Now what? Johns Hopkins Medicine. Retrieved August 25, 2022, from https://www.hopkinsmedicine.org/health/wellness-and-prevention/my-pap-test-was-abnormal-now-what

Gage, J. C., Schiffman, M., Katki, H. A., Castle, P. E., Fetterman, B., Wentzensen, N., Poitras, N. E., Lorey, T., Cheung, L. C., & Kinney, W. K. (2014). Reassurance against future risk of precancer and cancer conferred by a negative human papillomavirus test. JNCI Journal of the National Cancer Institute, 106(8). https://doi.org/10.1093/jnci/dju153

Naseri, S., Cruz, G. I., Young, S., & Blumenthal, P. D. (2022). Screening for high risk human papillomavirus using passively self-collected menstrual blood [A91]. Obstetrics & Gynecology, 139(1). https://doi.org/10.1097/01.aog.0000826692.81266.e9

National Institutes of Health. (2022, May 9). HPV and PAP testing. National Cancer Institute. Retrieved August 25, 2022, from https://www.cancer.gov/types/cervical/pap-hpv-testing-fact-sheet

Radboud UMC. (2022). Cervical cancer and HPV. Radboudumc. Retrieved August 20, 2022, from https://www.radboudumc.nl/en/research/themes/womens-cancers/cervical-cancer-and-hpv

RIVM. (2022, January 3). Cervical cancer screening programme. RIVM. Retrieved August 25, 2022, from https://www.rivm.nl/en/cervical-cancer-screening-programme

Robert Koch Institute. (2022, March 29). Cervical cancer. Krebs. Retrieved August 20, 2022, from https://www.krebsdaten.de/Krebs/EN/Content/Cancer_sites/Cervical_cancer/cervical_cancer_node.html 

About the Author

Lauren Dobischok

Lauren is a health scientist and science communicator living in the Netherlands. She has completed a Research Master in Health Sciences at Erasmus University Rotterdam’s Netherlands Institute for Health Sciences (NIHES) with a specialization in epidemiology, and a B.Sc. in Health Sciences at Simon Fraser University. With a background in public health, her goal is to create accurate scientific content that is easy to understand and enables people to make informed decisions. Within Homed-IQ, Lauren serves as Product Developer and Content Lead, working closely with medical doctors and medical device scientists on Homed-IQ’s new products and written communications.