How often should women get Pap smears for Human Papillomavirus (HPV) testing?

From the Guidelines

Women should generally get Pap smears with HPV testing every 3 to 5 years, depending on their age and risk factors, as recommended by the most recent guidelines 1. For women aged 21-29, Pap testing alone every 3 years is recommended. Women aged 30-65 can have either a Pap test every 3 years, HPV testing alone every 5 years, or co-testing with both Pap and HPV every 5 years. Some key points to consider include:

• Women younger than 21 typically don't need screening, and those over 65 with adequate prior normal screening can usually stop testing.
• However, women with certain risk factors like a history of cervical cancer, HIV infection, or immunosuppression may need more frequent screening.
• These recommendations aim to balance early detection of cervical abnormalities with avoiding unnecessary procedures, as HPV infections are common but most clear on their own without causing cancer.
• The longer interval for HPV testing is appropriate because the test detects the virus that causes cervical changes before they become visible on a Pap smear, allowing for earlier intervention when needed, as supported by recent studies 1. Some of the key evidence-based guidelines for cervical cancer screening include:
• The USPSTF recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years, and every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting) for women aged 30 to 65 years 1.
• The American Cancer Society recommends that women aged 30-65 years should be screened every 5 years with the combination of HPV testing and cytology, or every 3 years with cytology alone 1. It's essential to consider the individual patient's risk factors and medical history when determining the best screening approach, as some women may require more frequent screening or alternative screening methods, as noted in various studies 1.

From the Research

Pap Smear Screening Frequency for HPV Testing

The frequency of Pap smear screening for Human Papillomavirus (HPV) testing is a topic of interest, with various studies providing insights into the recommended screening intervals.

• According to a study published in 2004, the U.S. Preventive Services Task Force recommends cervical cancer screening to begin with the onset of sexual activity and be repeated at least every 3 years until age 65 2.
• Another study from 2004 found that among women with no history of abnormal smears, 55% undergo Pap smear screening annually, 17% report a 2-year screening interval, 16% report being screened every 3 years, and 11% are not being screened regularly 3.
• A 2005 study reported that almost all women aged 40 years or older (99%) had had at least one Pap smear, with most (59%) being screened annually 4.
• Research from 2008 measured abnormal Papanicolaou (Pap) tests and high-risk human papillomavirus (HPV) infection among demographically diverse women who received routine cervical screening, finding that high-risk HPV prevalence was highest among women age 14 to 19 years (35%) and lowest among women age 50 to 65 years (6%) 5.
• A 2013 study estimated the real-life risks and benefits of annual Papanicolaou (Pap) screening in HPV-negative women with normal cytology, finding that the long-term risk of high-grade neoplasia after an initial negative HC2 test and normal cytology result was low, while the rate of false-positive abnormal Pap smears was significant and increased constantly over time 6.

Screening Intervals

The recommended screening intervals for Pap smears vary, but most studies suggest that annual screening may not be necessary for all women.

• The U.S. Preventive Services Task Force recommends screening at least every 3 years until age 65 2.
• A study from 2004 found that lengthening the screening interval would not only reduce the volume of specimens that cytotechnologists are required to read, but would also reduce the follow-up testing after abnormal smears 3.
• Another study from 2013 suggested that Pap smear screening of HPV-negative women more frequently than every 5 years could be potentially harmful and seems to be of little clinical value 6.

Women's Attitudes Towards Screening

Women's attitudes towards less intense screening, specifically less frequent screening and eventual cessation of screening, vary.

• A 2005 study found that almost all women aged 40 years or older (99%) had had at least one Pap smear, with most (59%) being screened annually, and that 75% of women preferred screening at least annually 4.
• The same study reported that only 35% of women thought that there might come a time when they would stop getting Pap smears, and that the strongest predictor of reluctance to reduce the frequency of screening was a belief that cost was the basis of current screening frequency recommendations 4.