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Oral Cancer

Do Positive Pap Tests Indicate There is No Risk of Cancer?

05/09/2008

Question:

I`ve been in a committed lesbian relationship for the past two years. Both of us get our yearly pap smears (which always come back normal - we`ve never had an abnormal one that tested positive for hpv in the past). My question - with the recent link between HPV and oral cancer - could we be at risk? Are normal pap smear results sufficient to reassure us that we are not carriers of the high risk HPV (16/18)? Should we be doing anything else? Any thoughts would be appreciated!

Answer:

If you and your partner have had negative Pap smears and have no history of genital or oral warts, it is highly unlikely that you are at risk for oral HPV related lesions, especially in a mutually monogamous relationship. Human papilloma virus or HPV has been associated with up to 50% of the oral and throat cancers. Other important cofactors are any type of tobacco use. With that said, the converse is that HPV and oral-genital sex are both very common, yet few people get oral cancers.

With respect to your second question, repetitive normal Pap smears are very reassuring. If you are thirty or older, you can be screened with a high risk HPV test, along with your Pap, every three years. The American Cancer Society has approved triennial Pap plus HPV screening for women 30 and over, provided that they have a history of normal Paps. This is a very sensitive combination of tests. The other option is to continue with yearly Paps, also an excellent option.

Talk to your doctor about these options, if you are thirty or older, and check with your insurance company to make sure they cover the HPV test. The American Cancer Society does not recommend routine HPV testing in women under the age of thirty, unless it is used as a tool to determine if a mildy abnormal Pap is significant.  

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Response by:

Deborah A Bartholomew, MD Deborah A Bartholomew, MD
Clinical Associate Professor of Obstetrics & Gynecology
College of Medicine
The Ohio State University