The HPV vaccine is not a free pass: why regular pap smears still matter

Cervical cancer, a major public health issue in India, can largely be attributed to the Human Papillomavirus (HPV). In recent years, awareness around the HPV vaccine has grown significantly in India. The demand for the vaccine is growing due to increased awareness about cervical cancer prevention. The promotion of HPV vaccination, particularly among teenage girls, has been greatly aided by government initiatives, educational programmes, and assistance from health groups. This is further being accelerated by the incorporation of HPV vaccines into State-level immunisation programmes, while there are plans for a Central roll-out as well.

This is a welcome shift. HPV vaccination is a powerful preventive tool against cervical cancer, a disease that continues to claim the lives of thousands of Indian women every year. However, in my clinical practice, I often encounter a concerning misconception: many women believe that once vaccinated, they no longer need regular cervical cancer screening. This assumption can be risky.

Cervical health

The truth is simple yet important – the HPV vaccine does not replace Pap smears. Vaccination and screening must go hand in hand. The HPV vaccine protects against the most common high-risk strains of the virus that cause cervical cancer, particularly HPV types 16 and 18, which are responsible for nearly 70% of cases worldwide. Newer vaccines also cover additional strains and offer broader protection. However, no vaccine currently protects against all cancer-causing HPV types. This means there remains a small but significant risk of cervical cell changes even after vaccination.

A Pap smear, or cervical cytology test, serves a very different purpose. It does not prevent infection; instead, it detects early, abnormal changes in cervical cells, often long before symptoms appear. These changes can be treated effectively if identified on time, preventing progression to cancer.

When to screen

Another factor to consider is timing. Many women receive the HPV vaccine after becoming sexually active, sometimes even after exposure to the virus. While vaccination still offers benefits, it cannot eliminate infections that are already present. Regular screening becomes even more essential in such cases.

Worldwide, and in India too, it is recommended to screen all women for cervical diseases. For most women, it is recommended that they undergo cervical screening through Pap smear tests after turning 21. For some, it is recommended that they undergo both cervical screening tests and HPV DNA testing after turning 30.

Building awareness

Unfortunately, even today, fear and lack of awareness keep many women away from screening. Others assume that vaccination alone has made them “safe for life.” As doctors, we must correct this narrative. Cervical cancer is one of the most preventable cancers – but only if prevention is complete, not partial. It is also important to remember that cervical cancer often develops silently over years. There may be no warning signs until the disease is advanced. Regular Pap smears help catch changes at a stage when treatment is simple, minimally invasive, and highly successful.

Working closely with women and their families, I encourage women not to become complacent after being vaccinated. They must continue their regular health check-ups. They must ask questions and adhere to the screening schedules as recommended by their gynaecologist. They must encourage their daughters, their sisters, and their friends to do the same.

Cervical cancer prevention is one of modern medicine’s success stories, but only when we use all the right tools available to us. The HPV vaccine is an enormous breakthrough, but it is not a free pass. Regular Pap smears still matter, and they save lives.

(Dr. Sireesha Reddy is senior consultant – obstetrician & gynaecologist, Motherhood Hospitals, Bengaluru. drsireesha.r@motherhoodindia.com)