From the Guidelines
The current guidelines for PAP smear screening recommend that women begin screening at age 21, regardless of sexual history, with a PAP test every 3 years for women aged 21-29, and every 5 years with co-testing (PAP plus HPV testing) or every 3 years with PAP test alone for women aged 30-65. The guidelines are based on the understanding that cervical cancer incidence and mortality rates have declined since the introduction of the Papanicolaou (Pap) smear in the mid-20th century, and rates continue to decline 1.
Key Recommendations
- Women younger than 21 years should not be screened regardless of their age of sexual initiation, and women at any age should not be screened annually by any screening method 1.
- For women aged 30 to 65 years, the preferred approach is cotesting every 5 years with cytology and HPV testing, although it is also acceptable for women to continue to be screened every 3 years with cytology alone 1.
- Women should discontinue screening after age 65 years if they have had 3 consecutive negative cytology tests or 2 consecutive negative cotest results within the 10-year period before ceasing screening, with the most recent test occurring within the last 5 years 1.
Special Considerations
- Women who have had a total hysterectomy (including removal of the cervix) for non-cancerous reasons and have no history of cervical precancer or cancer can stop screening.
- Those with a history of cervical cancer, HIV infection, immunosuppression, or in-utero DES exposure may need more frequent screening 1.
Rationale
The guidelines are based on the natural history of HPV infection and cervical cancer development, which typically progresses slowly over years, allowing for effective detection through periodic screening while avoiding unnecessary procedures in low-risk populations 1.
From the Research
PAP Smear Guidelines
The guidelines for PAP (Papanicolaou) smear screening vary depending on several factors, including age, medical history, and risk factors.
- The U.S. Preventive Services Task Force recommends cervical cancer screening begin with the onset of sexual activity and be repeated at least every 3 years until age 65 2.
- Most women need not undergo Papanicolaou (Pap) smear screening annually, according to U.S. professional medical societies and the national health systems of all other industrialized nations 3.
- The French recommendations suggest stopping cervical cancer screening by cervico-uterine smear from 65 years of age, but this may not be suitable for all populations, especially those with a history of HPV or abnormal Pap smears 4.
Screening Frequency
The frequency of Pap smear screening also depends on individual risk factors and medical history.
- 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.
- Women with a history of abnormal Pap smears or HPV infection may require more frequent screening, with 80% undergoing annual screening 3.
- The proportion of invasive cervical cancer in the oldest patients is high, and these cancers are more evolved and have a more pejorative prognosis, highlighting the importance of continued screening in certain populations 4.
Special Considerations
Certain populations may require special consideration when it comes to Pap smear screening.
- Adolescents who are sexually active or have been exposed to HPV should undergo Pap smear screening, as cervical dysplasia and carcinoma in situ can occur during adolescence 5.
- Women over 65 years of age may not require annual screening, but those with a history of HPV or abnormal Pap smears may benefit from continued screening 4.
- The use of HPV testing, such as PCR, can be a useful tool in conjunction with Pap smear screening to detect high-risk HPV strains and identify women at increased risk of cervical cancer 6.