From the Guidelines
Annual Pap smears are no longer recommended for most women, and instead, cervical cancer screening guidelines suggest Pap tests every 3 years for women ages 21-29, and every 3-5 years for women ages 30-65, depending on the screening method used. The most recent guidelines, as outlined in the 2019 American Cancer Society recommendations 1, emphasize the importance of individualized screening approaches based on a woman's age, screening history, and risk factors.
Key Recommendations
- Women younger than 21 years should not be screened, regardless of their age of sexual initiation.
- Women aged 21-29 years should receive cytology screening every 3 years with either conventional or liquid-based Pap tests.
- For women aged 30-65 years, the preferred approach is cotesting every 5 years with cytology and HPV testing, or screening every 3 years with cytology alone.
- 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 before ceasing screening, with the most recent test occurring within the last 5 years.
Rationale
The extended screening intervals are supported by evidence that cervical cancer typically develops slowly over 10-20 years, and frequent testing can lead to unnecessary procedures for transient HPV infections that would resolve naturally 1. However, more frequent screening may be appropriate for those with risk factors like HIV infection, immunosuppression, DES exposure, or previous abnormal results.
Individualized Approach
It is essential to consult with a healthcare provider to determine the most appropriate screening schedule based on individual risk factors and medical history. The American Cancer Society recommendations 1 provide a framework for healthcare providers to make informed decisions about cervical cancer screening, taking into account the latest evidence and guidelines.
From the Research
Cervical Cancer Screening Recommendations
- The American College of Obstetricians and Gynecologists recommends cytology screening (Pap test) every 3 years for women aged 21-65, with the option of adding the HPV test (co-test) every 5 years for women aged 30-65 2.
- A study published in JAMA found that HPV vaccination at ages 9 through 12 years will likely prevent more than 90% of cervical precancers and cancers, and that cervical cancer screening should be performed with HPV testing, followed by genotyping and cytology testing if HPV-positive 3.
- Another study published in the Journal of Women's Health found that significant declines in Pap completion rates over time were observed in all age groups, including an unexpected decline in 21- to 29-year-old women, while Pap-HPV cotesting significantly increased among women aged 30-65 years 4.
Screening Intervals
- The recommended screening interval for HIV-infected women is annual Pap testing if the previous test result is normal, with referral for colposcopy if the test results show abnormalities greater than atypical squamous cells of undetermined significance (ASCUS) 5.
- For women without a history of cervical dysplasia, screening intervals of every 2-3 years are recommended, with screening starting no sooner than age 21 6.
Pelvic Examination
- The value of annual pelvic examination in asymptomatic women is debated, with some professional societies endorsing less than annual cervical cancer screening in healthy women 6.
- Bimanual examination is insensitive in detecting early ovarian cancer, with a high false-positive rate leading to patient anxiety, excessive diagnostic testing, and unnecessary surgical procedures 6.