To think in this situation a smear test is a waste of time?

[coffeeforone]

My nurse mentioned recently that smear tests only test for HPV, if you don't test positive for HPV then they won't look closely for pre-cancerous cell changes. Given this info I started wondering. DH and I were both virgins when we met. Assuming we both remain faithful, is it true that we can never contract HPV and so there is no point in the test?

Of course I will never stop being tested regularly (as I can never be 100% sure DH will always be faithful) but it did get me thinking, is this the only risk here?

Frog and lark are right. Screening works well at a population level but it is one size fits all.

You need to be aware of gynae stuff and what needs checking out. We could do with some really good up to date general gynae info available.

My area has rolled out the HPV testing so they won't look for abnormal cells unless you test positive for HPV. I tested negative so that was that. I won't go for smears going forward but just do a private urine test for HPV. If it comes back positive I will get a smear but if it's negative there is no point making an appt, undressing etc when they aren't even going to look at the cells.

My gp told me this too, that labs are checking first for hpv and then only doing the smear cgecks if positive for hpv. I find this concerning tbh as some cases of csncer could be missed, but then her answer for that was that cell changes take years to develop to cancer

I know someone whose ovarian cancer was picked up on a smear. It was an off-chance and still further advanced than anyone would have liked, but not going to happen for anyone else now.

You can still get cervical cancer without having HPV. It’s unusual but not impossible, i don’t/didn’t have HPV but still got CC picked up on my first ever smear.

@Melioration...how? Smears don’t detect OC.

Presumably they just got lucky with a loose cell

I thought all areas had now changed to checking further only if the sample is positive for HPV. It's certainly been like that here for almost a year, I'm quite surprised it's not nationwide.

Increasing the lower age for screening wasn’t to save costs - it was to prevent unnecessary treatment of changes in under-25s which they discovered would likely reverse naturally.

That was my understanding as well - I know a pp suggested false positives which all screening programs have were worth it but I've read a New Scientist article unfortunately behind a pay wall that suggests increased risk of miscarriage and premature births with unnecessary treatments – it’s much more a balancing of risks than it first appears.

In answer OP don't know - I'd assume lower risk, not no risk, as there is going to be a switch to HPV testing first in many areas.

Primary HPv testing is more sensitive than the older cytology method, it has a considerably lower false negative rate, but a higher false positive rate. It will result in more women being referred for further investigation, which has both its positives and its negatives. A negative HPv test is a more reliable indication of being at low risk of cervical cancer than a normal cytology result. There have been large scale studies on this, they are easily available online.

For the op, if either of you have had any sexual contact previous to each other, not just sex, then there is some risk of HPv.

Wait, so are we saying that if our daughters had the HPV vacc then they won’t need to have smear tests?

They still will Tinklylittlelaugh because the vaccine doesn’t cover all strains of HPV.

Cervical cancer jab women will 'only need three smears - suggests they'll need considerably fewer TinklyLittleLaugh.

"if either of you have had any sexual contact previous to each other, not just sex, then there is some risk of HPv."

but presumably all you'd need then is one negative HPV test now, then you'd be covered after that? (assuming you both remain faithful!)

YANBU, OP. I went for my smear recently and when the nurse told me that they now only test for HPV and if it’s negative, no further screening, I declined the test and went home.

I did look at the research and it does seem evidence based, that this is the most accurate and effective way of screening for cervical cancer.

However, I’m extremely low risk for HPV. And have had clear smears. And haven’t been sexually active since the last one.

I might do a private HPV test at home just to be certain but tbh I’m already certain.

I do think this new way of testing is going to reduce uptake of cervical screening which is possibly something they didn’t consider when introducing it.

There are high costs to false positive screening tests, in terms of distress, fear, side effects of unnecessary treatments, pregnancy complications, even suicides.
Plus the low chance of finding cervical cancer in a hpv negative patient combined with false positive rates of the test, means that most of the detected positives in this situation would be false positives. Clearly this does not make sense in a screening test. It's not primarily a cost saving measure to not test for cell changes in hpv negative women.
I do wonder why they aren't giving the hpv vaccine to boys as well as girls - that would seem a worthwhile extra cost, as it can cause cancer in men, and no man would want their wife or mother to get cancer

@eightoclock HPV vaccine is being started soon in boys - we have heard rumours of starting as soon as this autumn. If it wasn't, I would pay for my DS to have it privately. I know plenty of medics do, especially those that see the problems associated with male HPV, namely head and neck/ENT specialists.

I had a smear test today and was informed they are only testing for hpv

@frogsoup

There is an indication that HPv can lie dormant for years and years and at such a low viral load as to cause no harm and return a negative HPv test result, but then be triggered by something, perhaps an immune response or a period of immune suppression. It's still not a well understood virus at all, but it appears that repeated testing is best.

@eightoclock

The HPv test doesn't have a high rate of false positives in the sense it will show people as being positive for HPv when in fact they aren't. The high positive means that women who have HPv but no cervical abnormalities will be retested and potentially referred for colposcopy. They have HPv, that part is accurate, but the further investigations are potentially ultimately unnecessary for them.

It is true that finding out you have a sexually transmitted infection is often upsetting and difficult, however HPv amongst unvaccinated adults is so ubiquitous it's basically normal. Particularly amongst people under 30. The other negative is that over treating the cervix has consequences both psychologically and physically.

Ultimately, the (very good) evidence points to fewer women developing and dying of cervical cancer with primary HPv testing.

That's really interesting Wenttoseainasieve, thank you. But is it the case that if neither party has ever had any kind of sexual contact with anybody else ever (as in the OP), then she'd never have been infected in the first place? As the test now doesn't pick up the small number of cases in which cervical cancer develops without the presence of HPV, she'd be justified in that case in not bothering with further testing?

I paid for private cervical screening via BUPA last week and had an internal swab which was tested for HPV. The result was HPV negative and I received written confirmation that I would not need smear tests as long as I was swabbed for HPV every two years.

@princesskatethefirst

Do you mind me asking about your diagnosis? How did your cervix not look right, was that from the smear itself or secondary testing?

Sorry for the intrusive and personal question

My concern is the none HPV related cervical cancer. These would surely have been picked up by smears in the past? So does this mean that such cancer will now only be detected once a woman becomes symptomatic? Would this presumably be at a later stage? This really concerns me for my DC in the future as we have a family history of cervical cancer and cervical abnormalities.

I’m a lesbian who has never had sex with a man and tested HPV negative but I’ve had a cervical cone biopsy after I had severe abnormal cells picked up on a smear test. Being HPV negative doesn’t mean no risk and like others I am concerned at how some areas are changing smear tests as many cases will be missed in the name of saving money.