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The Not-So-Scary Truth About HPV

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By Margaret Polaneczky, MDSeptember 4, 2014
From the WebMD Archives

If you’ve been diagnosed with HPV infection, the first thing you need to do is take a deep breath.

Odds are, you’re going to be fine.

It’s not surprising that you’re scared.

You see, we want you to know that HPV infection is linked to cervical cancer, and that we have a vaccine that can prevent cervical cancers. So we’ve been educating you with campaigns and commercials.

But in our zeal to get you checked and vaccinated, we sort of forgot to tell you something equally important. That something is this:

Pretty much everyone — 80% of U.S. adults — will get HPV at least once in their lifetime.

The overwhelming majority of HPV infections do NOT lead to cervical cancer. From 90%-95% of the time, the infection clears, usually within 1-2 years, without you, or anyone, doing anything.

But if everyone has HPV, and most infections clear, then why do we bother to test for it?

HPV testing is better at finding precancerous lesions than a Pap smear, so what the Pap misses, the HPV test will find.

The HPV test is also good for weeding out the false-positive Pap smears. A mildly abnormal Pap smear can be safely ignored and repeated in a year if the HPV test is negative. This saves a lot of women unnecessary testing.

The other good thing about HPV testing is that if it’s negative, you’re really in the clear. So much so that if both the Pap and HPV test are normal, the risk for cervical cancer plummets, and you can safely wait up to 5 years between Pap smears.

The problem with HPV testing.

The problem with HPV testing is that it has a very high false-positive rate. Most of the women who have a positive HPV test actually do not have precancerous lesions. They just have HPV.

That’s what happened to NYC Councilwoman Melissa Mark-Viverito, who then went public with her HPV diagnosis on Twitter. After she had more testing, she found out that she was fine.

Of course, you don’t want to ignore the fact that your Pap is abnormal, or that you have HPV.

You should take it as a sign that you need to get your Pap smears regularly. Or if your doctor recommends it, have a simple office procedure called a colposcopy – a magnifying lens that looks for tiny abnormalities on the cervix that are too small to be seen by the naked eye but can be treated so that you never get cervical cancer.

But know that it would be unusual for you to actually have cervical cancer just because your HPV test is positive. This is about finding precancerous lesions and preventing cancer.

But I have “high-risk” HPV.

So does everyone else with a positive HPV test.

“High-risk” HPV subtypes are called that to distinguish them from the “low-risk” types that cause genital warts. HPV tests only check for the high-risk types. So by definition, if you’re HPV-positive, you have a high-risk strain. (Someone really needs to change the name of that test.)

The not-so-scary truth about HPV.

While it is true that having HPV is necessary for getting cervical cancer, it’s also true that almost all HPV infections do NOT lead to cancer.

Think of it this way: Getting in a car is necessary for having an automobile accident, but most of us will make it to our destination safely.

Same thing with HPV. The chain of events that leads to cervical cancer starts with HPV infection, but almost all the time something intervenes to prevent cancer. That something is called your immune system, the Pap smear, and sometimes, colposcopy.

If you have HPV, don’t be scared. But be smart.

If you have HPV, odds are overwhelming that you’re going to be fine. We’ve been testing for and preventing cervical cancer for years — ever since the Pap smear was introduced in the 1940s. What HPV testing adds is additional sensitivity to pick up those few cases the Pap smear misses, and the ability to fine-tune our management of very minimally abnormal Paps.

So if you have anything precancerous, between the HPV test and the Pap smear, we’ll find it and we’ll treat it. Years before it becomes cervical cancer.

So do be smart and get tested. And follow through on whatever is recommended based on that result.

But don’t be scared.

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