What are the recommended Pap (Papanicolaou) test screening intervals for women?

Recommended Pap Test Screening Intervals for Women

For women of different age groups, Pap testing should follow specific intervals: ages 21-29 every 3 years with Pap test alone, ages 30-65 preferably every 5 years with HPV co-testing or every 3 years with Pap test alone, and discontinuation after age 65 with adequate prior screening. 1, 2

Age-Based Screening Recommendations

When to Start Screening

• Cervical cancer screening should begin at age 21, regardless of sexual activity history 2, 3
• Women under age 21 should not be screened, even if sexually active 2, 4

Women Ages 21-29

• Screen every 3 years with conventional or liquid-based Pap tests 1, 2
• HPV testing is not recommended in this age group 1, 3

Women Ages 30-65

• Preferred approach: Pap test plus HPV DNA test (co-testing) every 5 years 1, 2
• Acceptable alternative: Pap test alone every 3 years 1, 3
• Co-testing allows for longer screening intervals due to increased sensitivity 2, 3

When to Stop Screening

• Women over age 65 should discontinue screening if they have had:
  • ≥3 consecutive negative Pap tests OR
  • ≥2 consecutive negative HPV and Pap co-tests within the last 10 years, with the most recent test occurring within the last 5 years 1, 5
• Women who have had a total hysterectomy with removal of the cervix for benign reasons should stop cervical cancer screening 1, 5

Special Populations

Women with Risk Factors

• Women with history of cervical cancer, HIV infection, immunocompromised status, or previous abnormal results may require more frequent screening 2, 5
• Women who have never been screened should have at least two negative smears one year apart, regardless of age 2, 5

Women with Hysterectomy

• Women who have had a total hysterectomy (with removal of the cervix) for benign reasons should discontinue screening 1, 2
• Women who have had a hysterectomy but still have a cervical cuff present may still need screening 3

Evidence Supporting Current Guidelines

• Extended screening intervals (every 3 years vs. annually) reduce potential harms of overtreatment while maintaining nearly the same level of cancer prevention 2, 3
• Screening effectiveness improves by less than 5% when comparing annual screening to every 3 years 2, 6
• For women aged 30-65, HPV co-testing allows for a longer 5-year screening interval due to the increased sensitivity of the combined approach 2, 7
• The incidence of cervical cancer among women age 70 and older who had at least one normal Pap smear in the previous 10 years is only three cases per 100,000 5

Common Pitfalls to Avoid

• Over-screening: Despite current guidelines, many women still undergo annual screening unnecessarily, increasing costs and potential harms 2, 6
• Under-screening high-risk populations: Women with previous abnormal results, immunocompromised status, or HIV infection require more vigilant screening 2, 5
• Confusing pelvic examination with Pap testing: Many women erroneously believe that a sample for Pap testing was taken during a routine pelvic examination when only an examination was performed 1
• Discontinuing screening too early: Women should not stop screening before age 65 unless they meet specific criteria for adequate prior screening 2, 5
• Screening after hysterectomy: Unnecessary in women who have had their cervix removed and have no history of high-grade lesions or cancer 2, 5

Trends in Screening Practices

• The percentage of women aged 21-29 receiving annual Pap tests has decreased from 78.1% to 67.0% between 2000-2010, showing movement toward the latest guidelines 4
• About one-third of women up-to-date on Pap testing report having a co-test with their most recent Pap test 8
• Despite access to screening, disparities exist by race, ethnicity, insurance status, and socioeconomic factors 8, 9