Cervical Cancer Screening for a 21-Year-Old Woman Who Has Never Had Sex
A 21-year-old female who has never had sex should still begin cervical cancer screening at age 21, regardless of sexual history, as recommended by current guidelines. 1
Current Screening Recommendations
The American Cancer Society (ACS) and other organizations have evolved their recommendations over time based on our understanding of cervical cancer and HPV:
- Previous guidelines (pre-2020): Begin screening at age 21 regardless of sexual history 2, 1
- Current ACS guidelines (2020): Begin screening at age 25 2
Key Points About Screening Initiation
- Sexual activity status does not affect the recommendation to begin screening at the appropriate age 2, 1
- HPV vaccination status also does not change screening recommendations 2
- The recommendation applies to all individuals with a cervix 2
Rationale Behind Current Guidelines
The shift in recommendations is based on several important findings:
- Very low incidence of cervical cancer in women under 25 years (only 0.8% of all cases in those aged 20-24) 2
- High rate of transient HPV infections in younger women that typically resolve without intervention 2, 1
- Risk of adverse obstetric outcomes from treatment of precancerous lesions that would likely regress if not treated 2
- Favorable benefit-to-harm balance for beginning screening at age 25 2
Screening Methods and Intervals
When screening begins:
- Ages 21-29: Every 3 years with cytology (Pap test) alone 2, 1
- Ages 30-65: Every 5 years with HPV and cytology co-testing (preferred) OR every 3 years with cytology alone 1
Important Considerations
- Annual screening is NOT recommended for any age group 1
- Despite updated guidelines, data shows many women under 21 still receive unnecessary Pap tests (25.1% according to 2013-2015 data) 3
- There is a trend toward acceptance of less frequent screening intervals, with more than half of women willing to adopt 3-year intervals 4
Special Circumstances
For women with specific risk factors such as:
- HIV infection
- Immunocompromised status
- In utero DES exposure
- Previous cervical cancer/high-grade precancerous lesions
More intensive screening protocols are required 1
Bottom Line
For this 21-year-old patient who has never had sex, the most current ACS guideline (2020) would recommend waiting until age 25 to begin screening 2, though other organizations still recommend beginning at age 21 regardless of sexual history 1. Given the extremely low risk of cervical cancer in women under 25 and the potential harms of unnecessary procedures, following the most recent ACS guideline to begin screening at age 25 would be reasonable.