Current Guideline for Pap Smear Screening in Asymptomatic Women Over 30
For asymptomatic women aged 30-65 years, the preferred screening strategy is co-testing with both Pap test and HPV DNA test every 5 years, with an acceptable alternative of Pap test alone every 3 years. 1, 2
Recommended Screening Options
Women over 30 have three evidence-based screening approaches:
- Option 1 (Preferred): Pap test plus HPV DNA test (co-testing) every 5 years 3, 1, 2
- Option 2 (Acceptable): Pap test alone every 3 years 3, 1, 2
- Option 3 (Acceptable): HPV testing alone every 5 years 2
The co-testing approach is preferred because it provides higher sensitivity than Pap testing alone, which justifies the extended 5-year screening interval. 2
When to Stop Screening
Women can discontinue cervical cancer screening at age 65 if they meet ALL of the following criteria:
- Have had ≥3 consecutive negative Pap tests OR ≥2 consecutive negative HPV and Pap co-tests within the last 10 years 3, 1
- The most recent test occurred within the last 5 years 3, 1
- No history of high-grade precancerous lesions (CIN2, CIN3) or cervical cancer 4
- Not otherwise at high risk 2
Women who continue screening after age 65 should do so only if they are in good health and would benefit from early detection and treatment. 3
Critical Exceptions Requiring Modified Screening
Women with a history of abnormal Pap smears cannot stop screening at age 65 using standard criteria. 4 These women require:
- Continued screening for at least 20 years after treatment for CIN2, CIN3, or adenocarcinoma in situ, even if this extends past age 65 4
- Documentation of adequate negative screening AFTER resolution of lower-grade abnormalities (ASC-US, LSIL, or CIN1) before cessation criteria apply 4
High-risk women requiring continued screening beyond standard guidelines include: 1, 4
- HIV-positive women
- Immunocompromised women (organ transplant recipients, chronic corticosteroid use)
- History of cervical cancer
- In utero exposure to diethylstilbestrol (DES)
These women should continue annual screening and should not follow standard cessation guidelines. 3, 2
Common Pitfalls to Avoid
Over-screening remains a significant problem in clinical practice. Despite guidelines recommending 3-5 year intervals, research shows that only 19-31% of physicians actually recommend guideline-concordant intervals, with most continuing to screen annually. 5, 6 This increases costs and potential harms without improving cancer detection. 1
Do not screen women who have had a total hysterectomy with removal of the cervix (unless they have a history of high-grade precancerous lesions or cervical cancer). 1, 2 These women should stop all cervical cancer screening.
Do not use HPV testing in women under age 30 for routine screening, as HPV infection is extremely common in this age group and usually clears spontaneously. 3, 1
Avoid the common misconception that co-testing requires more frequent screening. The addition of HPV testing actually allows for LESS frequent screening (every 5 years instead of every 3 years) due to increased sensitivity. 1, 2
Documentation and Follow-Up
Women should receive written documentation stating whether a Pap test was obtained during their visit, as self-reports are often inaccurate. 1 All positive results on screening tests should be followed with timely colposcopy according to ASCCP guidelines. 3