How often is a Pap (Papanicolau) test done?

Pap Test Screening Frequency Guidelines

Pap tests should be performed every 3 years for women aged 21-65 years, or every 5 years with HPV co-testing for women aged 30-65 years who prefer a longer screening interval. 1

Age-Based Screening Recommendations

When to Start Screening

• Begin cervical cancer screening at age 21 regardless of sexual history 1
• Do NOT screen women younger than 21 years (D recommendation) 1
• Do NOT use HPV testing alone or with cytology in women younger than 30 years (D recommendation) 1

Screening Frequency by Age Group

• Ages 21-29 years:

  • Pap test (cytology) every 3 years 1
  • No HPV testing in this age group

• Ages 30-65 years:

  • Option 1: Pap test (cytology) every 3 years 1
  • Option 2: Pap test plus HPV testing (co-testing) every 5 years 1

When to Stop Screening

• Women older than 65 years who have had adequate prior screening and are not at high risk can discontinue screening 1, 2
• "Adequate prior screening" means at least 3 consecutive negative Pap tests or 2 consecutive negative HPV and Pap co-tests within the last 10 years, with the most recent test occurring within 5 years 2

Special Populations

After Hysterectomy

• Women who have had a hysterectomy with removal of the cervix and no history of high-grade precancerous lesions (CIN 2/3) or cervical cancer should discontinue screening 1, 2
• Women who have undergone subtotal hysterectomy (cervix remains) should continue age-appropriate screening 2

High-Risk Women

• Women with a history of cervical cancer, high-grade precancerous lesions, in utero DES exposure, or who are immunocompromised (e.g., HIV positive) should continue screening beyond age 65 1, 2

Screening Trends and Concerns

Recent data shows declining screening rates across all age groups, with approximately 81% of eligible women reporting having a Pap test within 3 years 3. This decline is concerning, particularly among women aged 22-30 years, where the proportion who reported never having had a Pap test increased from 6.6% to 9.0% 4.

Common Pitfalls to Avoid

1. Annual screening is unnecessary - Despite traditional practice patterns, annual screening provides little additional benefit over the recommended 3-year interval for women aged 21-65 1

2. Screening women under 21 - Screening women younger than 21 years is not recommended regardless of sexual activity onset, as cervical cancer is extremely rare in this age group (only 0.1% of all cervical cancers) 1

3. Continuing screening unnecessarily after hysterectomy - Women who have had a total hysterectomy for benign disease with no history of CIN 2/3 do not need further screening 2

4. Stopping screening too early - Never discontinue screening before age 65 in average-risk women without adequate prior screening 2

5. Failing to verify screening history - Always document adequate prior screening before discontinuing at age 65 2

By following these evidence-based guidelines, clinicians can optimize the benefits of cervical cancer screening while minimizing potential harms from over-screening.