From the Guidelines
Pap smears should begin at age 21, with testing every 3 years until age 30, and then either continue every 3 years or switch to co-testing with HPV every 5 years until age 65, after which screening can stop if prior results have been normal 1.
Screening Guidelines
The American Cancer Society recommends the following screening guidelines for cervical cancer:
- Women aged 21-29 years: screening every 3 years with conventional or liquid-based Pap tests
- Women aged 30-65 years: screening every 5 years with both the HPV test and the Pap test (preferred) or every 3 years with the Pap test alone (acceptable)
- Women aged >65 years: stop cervical cancer screening if they have had ≥3 consecutive negative Pap tests or ≥2 consecutive negative HPV and Pap tests within the last 10 years, with the most recent test occurring in the last 5 years
Rationale
These recommendations aim to detect cervical cell changes early when treatment is most effective, while avoiding unnecessary testing in low-risk populations. The screening intervals balance the benefits of early detection against the potential harms of overscreening, such as unnecessary procedures for transient HPV infections that would resolve naturally.
Key Points
- Women who have had a total hysterectomy (including removal of the cervix) for non-cancerous reasons can discontinue screening
- Those with a history of cervical precancer should continue screening for at least 25 years, even if this extends beyond age 65
- The screening guidelines prioritize the detection of cervical cancer while minimizing the risks associated with overscreening, as supported by the most recent evidence 1.
From the Research
Recommended Age for Papanicolaou (Pap) Smear
- The recommended age for starting Papanicolaou (Pap) smear screening is 21 years old, as stated in the study 2.
- Screening should start no sooner than age 21, according to the American College of Obstetricians and Gynecologists and other professional societies, as mentioned in the study 3.
- Current guidelines from the US Preventive Services Task Force and the American Cancer Society recommend testing to begin at age 21 to 25 years old, as stated in the study 4.
Screening Intervals and Cessation
- Screening intervals recommended by professional organizations have changed over the past half century, with current recommendations suggesting intervals of no less than 2 years apart in women 21-29, and every 3 years in women 30 and over, assuming no prior history of cervical dysplasia, as mentioned in the study 3.
- Testing should stop at 65 years old if sufficient cessation criteria has been met, according to the study 4.
- Women with a history of adequate screening and not otherwise at high risk may discontinue cervical cancer screening after 65 years of age, as stated in the study 5.