Current Pap Smear Screening Guidelines
Cervical cancer screening should begin at age 21, with screening every 3 years for women aged 21-29 using conventional or liquid-based Pap tests, and for women aged 30-65, screening should be done every 5 years with both HPV and Pap tests (preferred) or every 3 years with Pap test alone. 1
Age to Start Screening
- Screening should begin at age 21 regardless of sexual activity history 1
- Previous guidelines that recommended screening within 3 years of onset of sexual activity have been replaced with this fixed age recommendation 1
- Starting at age 21 is based on the very low incidence of cervical cancer in younger women (only 0.1% of all cervical cancer cases occur in women under 21) 1
Screening Intervals
Women Aged 21-29
- Screen every 3 years with conventional or liquid-based Pap tests 1
- Annual screening is explicitly not recommended for this age group 2
Women Aged 30-65
- Preferred approach: Screen every 5 years with both HPV test and Pap test (co-testing) 1
- Acceptable alternative: Screen every 3 years with Pap test alone 1
- Annual screening is explicitly not recommended 2
When to Stop Screening
- Women older than 65 years who have had ≥3 consecutive negative Pap tests or ≥2 consecutive negative HPV and Pap tests within the last 10 years, with the most recent test occurring within the last 5 years, should stop cervical cancer screening 1
- Women who have had a total hysterectomy (with removal of the cervix) for benign reasons and have no history of high-grade precancerous lesions should discontinue screening 1
Special Considerations
- Women with a history of cervical cancer or high-grade precancerous lesions require different follow-up protocols 1
- Women who have had a hysterectomy but still have a cervical cuff present may still need screening 1
- Women with HIV infection or who are otherwise immunocompromised may require more frequent screening 1
Implementation Challenges
- Despite updated guidelines, many women continue to be screened annually - 48.5% report annual screening despite recommendations for extended intervals 3
- Only 6.3% of women report being screened on the recommended extended interval, although 34.4% indicated such intervals would be acceptable 3
- Approximately 14 million women aged 21-65 in the US have not been screened within the past 3 years 4
- Women without insurance, recent immigrants, and those without a usual source of healthcare have lower odds of being up to date with screening 4
Rationale for Current Guidelines
- Extended screening intervals (every 3 years vs. annually) reduce the potential harms of overtreatment while maintaining nearly the same level of cancer prevention 1
- Screening effectiveness improves by less than 5% when comparing annual screening to every 3 years 1
- The risk of false positives and unnecessary procedures is reduced with less frequent screening 1
- HPV co-testing allows for the longer 5-year interval in women 30-65 due to its increased sensitivity 1
These guidelines represent a significant shift from previous annual screening recommendations, balancing the benefits of early detection against the potential harms of overscreening and overtreatment.