From the Guidelines
Frequent Papanicolaou (Pap) smears can lead to unnecessary risks, including false-positive results, overtreatment of transient HPV infections, and increased healthcare costs, without providing additional health benefits. The current recommendation for most women is to have Pap testing every 3-5 years, rather than annually, as stated in the guidelines from the American College of Physicians 1. Excessive screening can result in false positive results that lead to unnecessary follow-up procedures such as colposcopies and biopsies, which can cause anxiety, discomfort, bleeding, infection, and in some cases, cervical scarring that might affect fertility or pregnancy outcomes.
Some of the key risks associated with frequent Pap smears include:
- False positive results, which can lead to unnecessary procedures and anxiety
- Overtreatment of transient HPV infections and mild cellular changes that would likely resolve on their own without intervention
- Increased risk of cervical scarring, bleeding, and infection from follow-up procedures
- Potential impact on future pregnancies, including preterm birth and cervical insufficiency
- Increased healthcare costs without improving cancer detection rates
The reason less frequent screening is now recommended is that cervical cancer typically develops slowly over years, with an estimated average time of 10 years for a high-grade precancerous lesion to progress to cervical cancer 1. This allows ample time for identification and treatment of such lesions, making annual screening unnecessary. The American College of Physicians guidelines recommend against annual testing in women, citing the potential harms of overscreening and the lack of additional benefits 1.
From the Research
Risks of Frequent Papanicolaou (Pap) Smears
- Frequent Pap smears can lead to false-positive results, overdiagnosis, anxiety, and unnecessary costs 2
- Screening under the age of 25 can lead to false-positive results or to treatment of lesions that may spontaneously regress 3
- Excessive screening may cause physical and psychological harm and may result in unnecessary health care expenditures 3
- The majority of American women report being screened for cervical cancer more frequently than recommended, which can lead to unnecessary follow-up testing after abnormal smears 4
Prevalence of Unnecessary Pap Smears
- Approximately 2.6 million young women (22.9%) reported having received a BPE in the last 12 months, with half of these examinations being potentially unnecessary 2
- An estimated 2.2 million young women (19.2%) reported having received a Pap test in the past 12 months, with 71.9% of these tests being potentially unnecessary 2
- Women under the age of 25 continue to undergo unnecessary screening for cervical cancer, with approximately 4% of women aged 15 to 19 and 33% of women aged 20 to 24 having Pap tests after the new guidelines were released 3
Patient Attitudes Towards Less Frequent Screening
- Most women in the United States prefer annual Pap smears and are resistant to the idea of less intense screening 5
- The strongest predictor of reluctance to reduce the frequency of screening was a belief that cost was the basis of current screening frequency recommendations 5
- Patient belief about Pap testing frequency was the strongest predictor of attitude toward less frequent Pap testing and was not based on knowledge of HPV 6