Should You Worry About HPV if You’re Over 25?

Just about everyone who is sexually active will be exposed to the human papilloma virus (HPV) at some point in their lives. Spread through any kind of skin-to-skin genital contact, it's very much the “common cold” of STIs. There are over 100 types of HPV, ranging from low-risk types that cause cosmetic symptoms (such as genital warts), to high-risk types that cause cervical cancer.

In 2021, there were an estimated 14,480 new cases of cervical cancer in the U.S., and approximately 99.7% of cervical cancers are caused by high-risk HPV infections. But it’s important to know that if you do screen positive for high-risk HPV, it doesn’t necessarily mean you’ll develop cancer. HPV infections typically clear up within a couple of months without treatment, and 90% of infections resolve within two years.

So why worry? Unfortunately, some high-risk HPV infections will lead to cervical cancer, which can be life-threatening if not detected and treated early. That’s why regular screening is so important. And the good news is that a new HPV test is making screening more effective and convenient.

What You Need to Know About Cervical Cancer Screening

If you’ve ever had a Pap test (aka Pap smear), you’ve been screened for cervical cancer. The Pap test looks for abnormal cells in the cervix before they become cancerous. The test involves having a doctor/nurse insert a speculum into the vagina to open the walls, and then scrape a sample of cells from the cervix to be examined for abnormal or pre-cancerous cells.

It’s typically recommended for all people with a cervix to get a Pap test once every 3 years — even if they have no symptoms or have had the HPV vaccine.

Although effective at detecting cancer, there are many disadvantages to the Pap test:

• In order to get the Pap test, you need to have access to a medical professional, and this may be difficult if you don’t have a primary care provider or live in a remote area.
• The Pap test procedure can feel uncomfortable and invasive, especially for those with genital pain or sexual trauma.
• Some people may fear the procedure or have feelings of embarrassment during the procedure.
• Depending on the quality of the sample, abnormal/precancerous cells may not be detected, making the results of a Pap test less reliable.

Changing the Standard for Cervical Cancer Screening

A new way to screen for cervical cancer is quickly becoming the gold standard. The HPV test screens for an HPV infection — vs. the presence of abnormal cells, as is done in the Pap screen — so can detect the “high risk” types of HPV that can be cancerous. This is a huge advantage in early detection and treatment since infections can be detected before young cells have even had the chance to become abnormal.

HPV testing also offers greater and longer-term protection against cervical cancer. The ACS calls for HPV testing once every 5 years (compared to a Pap test, which needs to be performed once every 3 years).

In July of 2020, the American Cancer Society (ACS) updated its guidelines, recommending the HPV test as the preferred method of screening. Other major health organizations are likely to follow and, in a few years, it’s likely that the Pap smear will be eliminated. Insurance companies are not currently required to cover the HPV test, but that’s also likely to change soon.

You may have seen ads for at-home HPV tests, which allow users to take their own vaginal swab at home, then mail it off to a testing center. One study found the results of at-home HPV tests to be as accurate as those taken in a clinic, but at-home tests do not detect all strains of HPV, so are not currently recommended as a primary screening method. But if you can’t get to a clinic, they are certainly better than no screening at all.

How to Protect Yourself Against Cervical Cancer

The reality is that HPV is too common to avoid. So the most effective way to protect yourself against cervical cancer is to get screened every 3 or 5 years, depending on which test you have access to. Talk to your healthcare provider about your options — and check with your insurance company about what they cover.

What about the HPV vaccine? The Gardisil-9 vaccine (also known as the HPV vaccine) is highly effective at protecting against 9 types of HPV that lead to cancers and genital warts. It is the safest vaccine available, with millions of doses administered and a low risk of serious side effects.

The HPV vaccine has the most benefit for individuals who have not yet been exposed to the virus, so the CDC recommends vaccination at 11 and 12 years of age. Catch-up vaccinations — for anyone who hasn’t had one yet — are recommended through the age of 26. Beyond that, the chances that an adult hasn’t been exposed to HPV are so low, the vaccine isn’t considered cost-effective. That said, if you’re between the ages of 26 and 45, haven’t been vaccinated, and believe your risk of HPV exposure has been low, talk to a healthcare provider about whether the vaccine may still be right for you.

Even if you’ve been vaccinated, regular screening for cervical cancer is critical, since the vaccine doesn’t protect against all types of high-risk HPV. If you’re not sure when you were last screened, ask a healthcare provider about scheduling one, ASAP.