How often should Pap (Papanicolau) smear and HPV (Human Papillomavirus) testing be performed?

From the Guidelines

Pap and HPV testing should be done every 5 years for individuals with a cervix aged 25 to 65 years, with primary HPV testing being the preferred method, as recommended by the American Cancer Society in 2020 1.

Screening Guidelines

The American Cancer Society recommends the following screening guidelines:

• Individuals with a cervix should initiate cervical cancer screening at age 25 years.
• Primary HPV testing every 5 years is the preferred screening method through age 65 years.
• If primary HPV testing is not available, cotesting (HPV testing in combination with cytology) every 5 years or cytology alone every 3 years are acceptable alternatives.

Age-Specific Recommendations

• For individuals aged 25 to 65 years, primary HPV testing every 5 years is recommended.
• For individuals aged >65 years with no history of cervical intraepithelial neoplasia grade 2 or more severe disease within the past 25 years, and who have documented adequate negative prior screening in the prior 10 years, all cervical cancer screening can be discontinued.

Importance of Adhering to Screening Intervals

Adhering to the recommended screening intervals is crucial to maintain a reasonable balance of benefits and harms, as more frequent screening can lead to additional procedures and assessment and treatment of transient lesions, which can cause harm 1.

Personalized Recommendations

It is essential to consult a healthcare provider for personalized recommendations based on individual health history, as certain risk factors may require more frequent screening.

From the Research

Pap and HPV Testing Frequency

The frequency of Pap and HPV testing is a crucial aspect of cervical cancer screening. According to the studies, the recommended frequency of testing varies based on age and other factors.

• Women between 21-65 years old are recommended to have a Pap test every 3 years or a Pap-HPV co-test at 5-year intervals 2.
• For women between 30-65 years old, Pap-HPV co-testing is recommended at 5-year intervals 2.
• The US Preventive Services Task Force recommends against testing women younger than 21 years regardless of sexual history, and suggests a Pap test every 3 years for women between 21-29 years old 3.

Screening Guidelines

The screening guidelines for cervical cancer have been updated to reflect the differences in HPV infections and cervical abnormalities in female adolescents and adults.

• The American Journal of Clinical Pathology study found that the 2012 screening guidelines did not have a detrimental impact on the outcomes of cervical cancer screening for 21- to 25-year-old women 3.
• The Journal of Women's Health study found that the adoption of the 2012 screening recommendations increased among women aged 30-65 years, with a significant increase in Pap-HPV co-testing from 10.0% in 2007 to 60.8% in 2016 2.
• The New England Journal of Medicine study found that screening for cervical cancer based on testing for human papillomavirus (HPV) increases the sensitivity of detection of high-grade cervical intraepithelial neoplasia 4.

Age-Specific Recommendations

The age-specific recommendations for Pap and HPV testing are as follows:

• For women under 21 years old, screening is not recommended regardless of sexual history 3, 5.
• For women between 21-29 years old, a Pap test every 3 years is recommended 3.
• For women between 30-65 years old, a Pap-HPV co-test at 5-year intervals or a Pap test every 3 years is recommended 2, 6.