How often should a woman get a Pap (Papanicolau) smear?

Pap Smear Screening Recommendations

Women should undergo cervical cancer screening with a Pap test every 3 years from ages 21-29, and for women ages 30-65, screening should be done every 5 years with both HPV and Pap tests (preferred) or every 3 years with the Pap test alone. 1

Age-Based Screening Guidelines

When to Start

• Begin cervical cancer screening at age 21 regardless of sexual history 1
• Screening before age 21 is not recommended, even if sexually active 1

Screening Intervals by Age

• Ages 21-29:

  • Pap test every 3 years 1
  • HPV testing alone or co-testing is NOT recommended in this age group 1

• Ages 30-65:

  • Preferred: Co-testing with both Pap test and HPV test every 5 years 1
  • Acceptable alternative: Pap test alone every 3 years 1

When to Stop

• Women older than 65 years should stop screening if they have had:
  • At least 3 consecutive negative Pap tests, or
  • At least 2 consecutive negative HPV and Pap co-tests within the last 10 years, with the most recent test occurring within the last 5 years 1
• Modeling data suggests continued testing after age 65 reduces cervical cancer mortality by only 0.18% at age 65 and 0.06% at age 74 1

Special Populations

After Hysterectomy

• Women who have had a total hysterectomy with removal of the cervix should stop cervical cancer screening 1
• Exception: Women with a history of high-grade precancerous lesions (CIN 2/3) or cervical cancer should continue screening 1

High-Risk Women

• Women at high risk of cervical cancer (history of cervical cancer, HIV infection, immunosuppression) may need more frequent screening 1
• Medicare covers yearly screening for women at high risk of cervical or vaginal cancer 1

Clinical Considerations

Effectiveness of Different Screening Intervals

• Annual screening compared to every 3 years improves screening effectiveness by less than 5% 1
• Despite recommendations for longer intervals, studies show that 55% of American women still undergo annual Pap testing 2

Impact of Screening

• Regular Pap smear screening can reduce cervical cancer cases by approximately 80% 3
• Studies show that women who have never had a Pap test or are screened infrequently are at highest risk for developing cervical cancer 3

Common Pitfalls to Avoid

• Over-screening: Annual screening is not recommended for any age group and provides minimal additional benefit 1
• Under-screening: Approximately 14 million women aged 21-65 have not been screened within the past 3 years 4
• Screening after hysterectomy: Unnecessary in women without a cervix unless they have a history of high-grade lesions or cervical cancer 1
• Stopping too early: Women should continue screening until age 65-70 if they have adequate prior screening and no history of significant abnormalities 1

Remember that these recommendations apply to asymptomatic women with no history of cervical cancer or high-grade precancerous lesions. Women with symptoms such as abnormal bleeding should receive appropriate diagnostic evaluation regardless of their screening history.