How often should you get a Pap (Papanicolau) test?

How Often Should You Get a Pap Test?

For women aged 21-29 years, get a Pap test every 3 years; for women aged 30-65 years, get either a Pap test alone every 3 years or preferably a Pap test plus HPV test (co-testing) every 5 years. 1

Age-Specific Screening Intervals

Women Ages 21-29 Years

• Begin screening at age 21, regardless of sexual activity history 1, 2
• Screen with Pap test alone every 3 years 1
• Do NOT use HPV testing in this age group for routine screening, as HPV infections are common and typically transient in younger women 1

Women Ages 30-65 Years

• Preferred option: Pap test plus HPV co-testing every 5 years 1
• Alternative option: Pap test alone every 3 years 1
• The 5-year interval with co-testing is safe due to the increased sensitivity of the combined approach 1

Women Under Age 21

• Do not screen, regardless of sexual activity 1
• Cervical cancer incidence is extremely low (only 1-2 cases per 1,000 females aged 15-19 years) 2

Women Over Age 65

• Stop screening if you have had adequate prior screening with normal results 1, 3
• Adequate screening means 3 consecutive negative Pap tests OR 2 consecutive negative co-tests within the past 10 years, with the most recent test within 5 years 3
• Once stopped, do not resume screening for any reason, even with a new sexual partner 3

Special Populations Requiring Different Intervals

After Hysterectomy

• Stop screening if your cervix was removed and you have no history of high-grade precancerous lesions or cervical cancer 1
• Continue screening if hysterectomy was performed for cervical cancer or precancerous lesions 4

High-Risk Women

Continue more frequent screening if you have: 1

• History of cervical cancer or high-grade precancerous lesions
• HIV infection or immunocompromised status
• History of persistent high-risk HPV infection
• Previous abnormal Pap results

For high-risk women, screening intervals should be determined by clinical judgment and may require annual testing 1

Critical Evidence Supporting These Intervals

The 3-year interval for Pap testing is strongly supported by evidence showing that annual screening (every 1-2 years) compared to every 3 years improves screening effectiveness by less than 5% 4, 1. This minimal benefit does not justify the increased costs, patient burden, and potential harms from more frequent testing.

For women aged 30-65, adding HPV testing allows safe extension to 5-year intervals because the combined approach has much higher sensitivity for detecting precancerous lesions 1.

Common Pitfalls to Avoid

Over-Screening

• Annual Pap tests are not recommended for average-risk women 1
• Despite guidelines, research shows 65% of women still get tested annually, and 81% expect to be screened again within 1 year 5, 6
• Over-screening increases costs and potential harms (anxiety, unnecessary procedures) without meaningful benefit 1

Under-Screening High-Risk Groups

• Women who are recent immigrants, uninsured, or without a usual healthcare source have significantly lower screening rates 5
• An estimated 14 million eligible women aged 21-65 have not been screened within the past 3 years 5

Screening After Age 65

• Do not continue screening in adequately screened women, as modeling shows continued testing reduces cervical cancer mortality by only 0.18% at age 65 and 0.06% at age 74 4, 3
• The exception is women with inadequate prior screening or high-risk factors 3

Screening Too Young

• Starting before age 21 leads to detection and treatment of transient HPV infections that would resolve spontaneously, causing unnecessary anxiety and procedures 2

Medicare Coverage

Medicare covers Pap testing at 3-year intervals for average-risk women, with annual screening allowed for high-risk women (those with abnormal Pap smears in the preceding 3 years or at high risk for cervical or vaginal cancer) 4, 1.