I encourage you to use the idea of “piggybacking” messages.  It is now time to deliver the message for women of all ages:

1. A Pap test every 3 years from age 21 to 65. If she is in that age range and has a borderline Pap result, (an abnormal Pap that is not clearly normal), we will test for HPV.
   • I like to tell women this before the fact, so that patient isn’t dealing with the “double whammy”, i.e., not only was your Pap not normal, but you tested positive for an infection you may not have heard of that is cancer-causing and passed sexually.
   • I try to tell women in advance that HPV is cause the of abnormal Pap results.  If your Pap is inconclusive, we will test for HPV from the same vial that we already took from you at your visit.  
     
     
2. If you are age 30-65, it is preferred that we do Pap plus HPV testing.
   
   
3. In terms of ASC-US triage, it is appropriate for all women age ≥21 who receive a Pap.
   
   
4. Co-testing summary:  
   
   • Pap plus HPV testing regardless of how the Pap is read is screening-appropriate for women ages 30 - 65.
   • Women ages 21- 29 will receive an HPV test if you do reflex testing from an ASC-US cytology result.
     
     
5. HPV vaccination is approved for young men and women ages 9 to 26.