What are the guidelines for women's Pap (Papanicolaou) smear screening?

Cervical Cancer Screening Guidelines for Women

Women should begin cervical cancer screening at age 21, with screening every 3 years using cytology (Pap test) alone for ages 21-29, and preferably every 5 years with HPV and cytology co-testing (or every 3 years with cytology alone) for ages 30-65, as recommended by major medical organizations. 1

Age-Based Screening Recommendations

Ages 21-29

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

Ages 30-65

• Preferred approach: HPV and cytology co-testing every 5 years 1
• Acceptable alternative: Cytology alone every 3 years 1
• Annual screening is NOT recommended for any age group 1

When to Stop Screening

• Women can discontinue screening at age 65 if they have had:
  • At least 3 consecutive negative Pap tests or 2 consecutive negative co-tests within the past 10 years
  • Most recent test occurring within the past 5 years 1
• Never discontinue screening before age 65 in average-risk women 1

Special Populations

Post-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 1
• Women with a subtotal hysterectomy (cervix remains) should continue age-appropriate screening 1

High-Risk Women

• Women with HIV infection should have a Pap test twice in the first year after diagnosis, then annually if results are normal 1
• Women with a history of cervical cancer, high-grade precancerous lesions, in utero DES exposure, or immunocompromised status should continue screening beyond age 65 1

HPV Testing Guidelines

• FDA-approved HPV tests are not recommended for women aged <20 years for screening or management of abnormal Pap tests 2
• HPV testing should not be used for screening women in the 21-29 age group 1
• HPV DNA testing is not recommended for:
  • Deciding whether to vaccinate for HPV
  • Conducting STD screening for HPV
  • Screening for primary cervical cancer as a stand-alone test (without a Pap test) 2

Implementation Considerations

• Healthcare providers should discuss the purpose and importance of cervical cancer screening with patients 2
• When performing pelvic examinations for STD screening, providers should inquire about the patient's most recent Pap test 2
• Extending screening intervals from annual to every 3 years with cytology alone reduces screening effectiveness by less than 5% 1
• Despite evidence-based recommendations for less frequent screening, studies show many women still receive annual Pap tests 3, 4
• Recent trends show increasing adoption of 2012 screening guidelines with more women receiving Pap-HPV cotesting and fewer receiving annual Pap tests 5

Common Pitfalls to Avoid

1. Screening women under age 21 (not recommended regardless of sexual activity) 1
2. Annual screening for any age group (not evidence-based and may lead to overtreatment) 1
3. Failing to transition to co-testing for women 30-65 years old 1
4. Discontinuing screening too early (before age 65) or without verifying adequate prior screening 1
5. Continuing screening unnecessarily after total hysterectomy for benign disease 1
6. Confusing pelvic examinations with Pap testing (many women erroneously believe a pelvic exam includes a Pap test) 2

By following these evidence-based guidelines, healthcare providers can maximize the benefits of cervical cancer screening while minimizing potential harms from overscreening.