Pap Testing and HPV Screening Age Recommendations

Pap testing for cervical cancer screening should begin at age 21 years, regardless of sexual activity history. 1, 2

Current Age-Based Recommendations

Screening should begin at age 21 years, regardless of when sexual activity started, according to the American College of Obstetricians and Gynecologists (ACOG) and American Cancer Society (ACS) 2, 1
For women aged 21-29 years, screening should be performed every 2 years 1, 2
For women aged 30 years and older with normal results, screening can be extended to every 3 years 1, 2
Women aged 30 years and older may also opt for HPV co-testing with Pap test every 5 years 1, 3
Screening may be discontinued at age 65-70 years after 3 consecutive normal tests in the last 10 years 1, 2

HPV co-testing is not recommended for women under age 30 2
HPV testing can be used in conjunction with Pap tests for women aged ≥30 years 2
High-risk HPV DNA tests are recommended for the triage of women aged ≥21 years who have ASC-US (atypical squamous cells of undetermined significance) cytology results 2
HPV DNA testing is not recommended for women aged <20 years for screening or management of abnormal Pap tests 2

The incidence of cervical cancer in women younger than 21 years is extremely low (only 0.1% of all cervical cancer cases) 2, 1
The annual incidence is only 1-2 cases per 1,000 females aged 15-19 years 2, 1
There are concerns about potential harms from anxiety and unnecessary procedures following positive tests in young women 2, 1
Most HPV infections in young women are transient and will resolve spontaneously without causing cervical abnormalities 4, 5

Women with hysterectomy (with cervix removed) for benign reasons can discontinue screening 1, 2
Women at high risk (HIV positive, immunocompromised, history of cervical cancer) may require more frequent screening 1, 2
Women who have received HPV vaccination should still follow the same screening guidelines as unvaccinated women 2, 5

Earlier guidelines (pre-2010) recommended screening approximately 3 years after first vaginal intercourse but no later than age 21 years 2
Since 2010, major organizations have shifted to recommending starting screening at age 21 years regardless of sexual activity 2, 1
The American Cancer Society updated their guidelines in 2020 to recommend starting screening at age 25 years, citing the low incidence of cervical cancer in women under 25 1

Do not begin screening before age 21, even in sexually active adolescents 2, 1
Do not use HPV testing alone as a primary screening test without Pap testing 2
Do not assume that HPV vaccination eliminates the need for regular screening 5, 2
Do not screen too frequently, as this can lead to unnecessary procedures with potential harm 2, 6
Do not discontinue screening prematurely before age 65-70 without adequate prior normal results 2, 1