From the Guidelines
Pap smears should be ordered for women starting at age 21, regardless of sexual activity, and continued until age 65 if previous results have been normal. For women aged 21-29, Pap testing alone should be performed every 3 years, as recommended by the American Cancer Society 1. For women aged 30-65, options include Pap testing every 3 years, HPV testing alone every 5 years, or co-testing with both Pap and HPV every 5 years, with the preferred approach being co-testing every 5 years 1. Some key points to consider when ordering a Pap smear include:
- Women who have had a total hysterectomy (including removal of the cervix) for non-cancerous reasons can discontinue screening 1.
- Those with a history of cervical cancer, high-grade precancerous lesions, or immunocompromised status may need more frequent screening.
- When ordering a Pap smear, specify if HPV co-testing is desired, and note any relevant history such as abnormal previous results or symptoms. The rationale for these recommendations is based on the natural history of HPV infection and cervical cancer development, which typically progresses slowly over years, allowing for effective screening at these intervals while minimizing unnecessary procedures for younger women who often clear HPV infections spontaneously 1.
From the Research
Orders for a Papanicolo (Pap) Smear
- The orders for a Papanicolo (Pap) smear vary based on age and screening history, with guidelines recommending:
- Screening for cervical cancer among women 30 years or older 3 years after a normal Papanicolaou test result or a combined normal screening result (normal Pap/negative human papillomavirus [HPV] test results) 2
- Pap testing every 3 years for women age 21-65 years or Pap-human papillomavirus (HPV) cotesting at 5-year intervals for women age 30-65 years 3
- Deferring Pap smear screening to intervals no less than 2 years apart in women 21-29, and every 3 years in women 30 and over assuming no prior history of cervical dysplasia 4
- For women over 65 years old, clinical guidelines recommend that those with a history of adequate screening and not otherwise at high risk may discontinue cervical cancer screening 5
- The American College of Obstetricians and Gynecologists and other professional societies have issued guidelines for cervical cancer screening, including the use of HPV testing and Pap smears 4
Screening Intervals
- A study found that among Pap test providers who recommend HPV testing, 31.8% reported that they would conduct the next Pap test in 3 years for a 35-year-old woman with 3 normal Pap test results 2
- For a 35-year-old woman with a normal Pap test result and a negative HPV test finding, only 19.0% would conduct the next Pap test in 3 years 2
- Most remaining physicians would conduct the Pap test more frequently 2
Special Considerations
- Women who have undergone hysterectomy no longer need screening unless high-grade dysplasia was present 4
- The value of pelvic examination is not debated in women with symptoms referable to the female genital tract, but the endorsement by several professional societies of less than annual cervical cancer screening in healthy women also begs the question of whether annual pelvic examination benefits asymptomatic women 4