What is the recommended age range for cervical pap (Papanicolaou) smears?

Recommended Age Range for Cervical Pap Smear Screening

Cervical cancer screening with Pap smears should begin at age 21 and continue until age 65 for women with adequate prior screening and no high-risk factors, regardless of sexual history.

Screening Initiation

• Screening should begin at age 21 regardless of sexual history 1
• Starting screening before age 21 is not recommended as it provides no additional benefit in reducing cervical cancer incidence or mortality 2, 1
• Early screening can lead to unnecessary interventions for transient lesions that would likely regress naturally 1
• The USPSTF explicitly gives a "D" recommendation (recommends against) for screening women younger than 21 years 2

Screening Frequency

• For women aged 21-29 years:

  • Screen every 3 years with cytology (Pap smear) alone 1
  • HPV testing or co-testing is not recommended in this age group 2

• For women aged 30-65 years:

  • Option 1: Continue screening every 3 years with cytology alone 2, 1
  • Option 2: Screen every 5 years with co-testing (cytology plus HPV testing) 2, 1
  • Annual screening is explicitly not recommended by major guidelines 1

Discontinuation of Screening

• Women can discontinue screening at age 65 if they have had:

  • At least 3 consecutive negative Pap tests within the past 10 years, with the most recent test occurring within the past 5 years 2, 1
  • OR at least 2 consecutive negative HPV and Pap co-tests within the past 10 years, with the most recent test occurring within the past 5 years 1

• The USPSTF explicitly gives a "D" recommendation (recommends against) for screening women older than 65 who have had adequate prior screening 2

Special Populations

Women with Hysterectomy

• Women who have had a total hysterectomy (with removal of the cervix) for benign reasons and no history of high-grade precancerous lesions should discontinue screening 2, 1
• Women who have had a subtotal hysterectomy (cervix remains) should continue age-appropriate screening 1

High-Risk Women

• Screening should continue beyond age 65 in women with:
  • History of cervical cancer
  • High-grade precancerous lesions
  • In utero DES exposure
  • Immunocompromised status 1
  • New sexual partners 1

Implementation Considerations

• Despite guidelines recommending against screening women ≥70 years, approximately 40.8% of women in this age group reported having a Pap smear within the past 3 years 3
• Provider recommendation strongly influences screening behavior in older women, with those receiving a recommendation being 10.5 times more likely to obtain a Pap test 3
• Screening rates for women aged 21-29 years have been declining appropriately, moving toward alignment with guidelines 4
• There has been increasing adoption of Pap-HPV co-testing among women aged 30-65 years, from 10.0% in 2007 to 60.8% in 2016 5

Potential Harms of Inappropriate Screening

• Screening outside recommended age ranges can lead to:
  • Unnecessary diagnostic procedures
  • Psychological distress from false-positive results
  • Potential treatment of transient lesions that would regress naturally
  • Increased healthcare costs 1
  • Adverse pregnancy outcomes from treatment of precancerous lesions in young women 1

By following these evidence-based guidelines for cervical cancer screening, clinicians can maximize benefits while minimizing potential harms to patients across different age groups.