How often should a woman get a pap smear (Papanicolau test)?

Cervical Cancer Screening Recommendations

Women should undergo cervical cancer screening with cytology (Pap smear) every 3 years from ages 21 to 65, or for women aged 30 to 65 who want to lengthen the screening interval, screening with a combination of cytology and HPV testing every 5 years. 1

Screening Recommendations by Age Group

Ages 21-29

• Begin screening at age 21 regardless of sexual history
• Screen every 3 years with cytology (Pap smear) alone
• HPV testing is NOT recommended in this age group 1

Ages 30-65

• Screen every 3 years with cytology (Pap smear) alone OR
• Screen every 5 years with HPV and cytology co-testing (for women who want to lengthen screening interval) 1

After Age 65

• Discontinue screening if:
  • Woman has had adequate prior screening (at least 3 consecutive negative Pap tests or 2 consecutive negative HPV and Pap co-tests within the last 10 years)
  • Most recent test was within the past 5 years
  • No history of high-grade precancerous lesions or cervical cancer 2

Special Circumstances

• Women who have had a total hysterectomy with removal of the cervix for benign reasons and no history of high-grade precancerous lesions (CIN 2/3) or cervical cancer should discontinue screening 1
• 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

Evidence and Rationale

The 2012 USPSTF recommendations represent the most recent comprehensive guidelines and align with other major organizations. These guidelines moved away from annual screening based on evidence showing little advantage of annual versus less frequent screening intervals 1.

Despite these evidence-based guidelines recommending less frequent screening, studies show that many women continue to be screened annually. A 2017 study found that 55% of American women without a history of abnormal results were still undergoing annual Pap testing 3. This overscreening can lead to unnecessary procedures, treatment, and psychological distress 4.

Common Pitfalls to Avoid

1. Starting screening too early: Do not begin screening before age 21, regardless of when sexual activity began 1

2. Screening too frequently: Annual screening is no longer recommended for any age group 1

3. Using HPV testing in women under 30: HPV testing alone or with cytology is not recommended for women under 30 years 1

4. Continuing screening unnecessarily after hysterectomy: Women who have had a total hysterectomy with cervix removal for benign disease do not need further Pap testing 2

5. Stopping screening prematurely: Never discontinue screening before age 65 in average-risk women without confirming adequate prior screening 2

6. Continuing screening indefinitely: Women over 65 with adequate prior normal screening can safely discontinue screening 1, 2

The evidence clearly supports these screening intervals as providing the optimal balance between detecting cervical abnormalities while minimizing the harms of overscreening. Patient education about the rationale for less frequent screening is essential, as many women express discomfort with extending screening intervals 4.