From the Guidelines
Adult women should undergo a Papanicolaou (Pap) smear every 3 years starting at age 21, with the option to extend the interval to every 5 years if HPV co-testing is performed along with the Pap smear for women aged 30-65. This recommendation is based on the guidelines issued by the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology in 2012, as well as the US Preventive Services Task Force (USPSTF) recommendations 1.
The screening guidelines recommend different surveillance strategies and options based on a woman’s age, her screening history, other risk factors, and the choice of screening tests. Key points to consider include:
- Screening for cervical cancer should begin at age 21 years, with women aged 21 to 29 years receiving cytology screening every 3 years 1.
- Women aged younger than 21 years should not be screened regardless of their age of sexual initiation 1.
- For women aged 30 to 65 years, the preferred approach is to be screened every 5 years with the combination of HPV testing and cytology (“cotesting”), although it is also acceptable to continue screening every 3 years with cytology alone 1.
- Women should discontinue screening after age 65 years if they have had 3 consecutive negative cytology tests or 2 consecutive negative cotest results within the 10-year period prior to ceasing screening, with the most recent test occurring within the last 5 years 1.
It is essential to note that these recommendations may vary based on individual risk factors, such as HIV infection, immunosuppression, DES exposure in utero, or previous abnormal results, which may require more frequent screening 1. The Pap smear is a highly effective screening test because cervical cancer typically develops slowly over years, giving ample opportunity for detection and treatment of precancerous lesions. To ensure accurate results, women should schedule their Pap smear when they're not menstruating and avoid douching, using vaginal medications, or having intercourse for 24-48 hours before the test.
From the Research
Recommended Frequency for Pap Smear
The recommended frequency for adult women to undergo a Papanicolaou (Pap) smear is as follows:
- Women aged 21-30 years: every 3 years 2
- Women aged 30-65 years: every 3 years with cytology (Pap smear) or every 5 years with a combination of cytology and human papillomavirus (HPV) testing 3
- Women with no history of abnormal smears: screening intervals of 3 years are recommended, with yearly screening not being necessary 4
Screening Intervals
Some studies have found that:
- Many women are being screened more frequently than recommended, with 55% of women with no history of abnormal smears undergoing Pap smear screening annually 4
- Physicians may not always recommend guideline-consistent screening intervals, with only 19.0% of physicians recommending a 3-year screening interval for a 35-year-old woman with a normal Pap test result and a negative HPV test finding 5
- Women's acceptance of less frequent cervical cancer screening may be influenced by their healthcare provider's recommendation, with over two thirds of women willing to undergo less frequent screening if recommended by their provider 6
Barriers to Screening
Barriers to cervical cancer screening, particularly among immigrant women, may include: