From the Guidelines
Pap smears should begin at age 25 for women, regardless of sexual activity status, as recommended by the most recent guidelines from the American Cancer Society 1.
Rationale for Recommendation
The decision to start Pap smears at age 25 is based on the latest evidence and guidelines, which take into account the natural history of cervical cancer and the role of human papillomavirus (HPV) in its development.
- The American Cancer Society's 2020 guideline update recommends starting cervical cancer screening at age 25, citing the low burden of cervical cancer among women aged 20 to 24 years 1.
- Previous guidelines recommended starting screening at age 21, but the new recommendation reflects a re-examination of the evidence and a consideration of the balance of benefits and harms of screening in younger women.
Screening Frequency and Method
After starting screening at age 25, women should continue to be screened every 3 years until age 30, and then can opt for Pap testing every 3 years or co-testing (Pap plus HPV test) every 5 years until age 65.
- Women younger than 25 generally do not need Pap smears because cervical cancer is rare in this age group and HPV infections often clear naturally.
- For those over 65 with adequate prior screening and no history of significant abnormalities, Pap smears can usually be discontinued.
Special Considerations
Women who have had a total hysterectomy (including removal of the cervix) for non-cancerous reasons typically do not need continued screening.
- These recommendations may vary for individuals with certain risk factors, such as HIV infection, immunosuppression, or previous abnormal results, who might need more frequent screening. The purpose of Pap smears is to detect precancerous changes in cervical cells early, when treatment is most effective at preventing cervical cancer.
Evidence Summary
The evidence supporting the new recommendation to start Pap smears at age 25 includes data on the burden of cervical cancer among women aged 20 to 24 years, as well as studies on the performance of primary HPV testing in populations younger and older than ages 30 to 35 years 1.
From the Research
Cervical Cancer Screening Guidelines
- The American Cancer Society recommends that women have cervical cancer screenings regularly until age 65 2.
- Women with a cervix should be screened with HPV testing, and if HPV-positive, genotyping and cytology testing should be performed to assess the risk of cervical precancer and determine the need for colposcopy or treatment 3.
- Cervical cancer screening is effective in identifying precancerous lesions and allows for interventions that can prevent the development of cancer 4, 5.
Pap Smear Screening Age
- The recommended age to start Pap smear screening is 21 years old 3.
- Women should continue to have Pap smear tests until age 65, as recommended by the American Cancer Society 2.
- HPV vaccination at ages 9 through 12 years will likely prevent more than 90% of cervical precancers and cancers 3, and vaccination is ideally administered at 11 or 12 years of age, irrespective of the patient's sex 4.
Screening Frequency
- For people with current precancer risks of less than 4%, repeat HPV testing is recommended in 1,3, or 5 years depending on 5-year precancer risk 3.
- Women who have gone through menopause are less likely to have a pap smear test four or eight years later compared to those who were still premenopausal or perimenopausal at baseline 2.