Pap Smear Screening Frequency
For women aged 21-29 years, perform Pap testing every 3 years; for women aged 30-65 years, perform either Pap testing every 3 years or Pap plus HPV co-testing every 5 years (preferred option). 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 or management of abnormal results 1
Women Ages 30-65 Years
- Preferred approach: Pap test plus HPV DNA co-testing every 5 years 1
- Alternative approach: Pap test alone every 3 years 1
- The 5-year interval with co-testing is supported by increased sensitivity of the combined approach 1
- Evidence shows that screening every 1-2 years compared to every 3 years improves effectiveness by less than 5%, making annual screening unnecessary 3, 1
When to Stop Screening
Standard Cessation Criteria
- Discontinue screening at age 65 if the woman has had 3 consecutive negative Pap tests or 2 consecutive negative co-tests within the past 10 years, with the most recent test within the past 5 years 1, 4
- Once screening is discontinued, it should not resume for any reason, even if the woman reports a new sexual partner 4
Exceptions Requiring Continued Screening Beyond Age 65
- History of CIN2, CIN3, or adenocarcinoma in situ requires continued screening for at least 20 years after treatment, even if this extends past age 65 4
- HIV infection or immunocompromised status 1, 4
- History of cervical cancer 4
- Inadequate documentation of prior screening 4
Special Populations
Post-Hysterectomy
- Discontinue screening if the cervix was removed and there is no history of high-grade precancerous lesions or cervical cancer 1, 4
- Continue screening if hysterectomy was performed for cervical cancer or its precursors 3, 4
High-Risk Women
- Women with persistent high-risk HPV types require more frequent screening 1
- Previous abnormal Pap results necessitate more frequent screening 1
- Multiple sexual partners, smoking, or low socioeconomic status may warrant increased screening frequency 3
Never-Screened Women
Critical Pitfalls to Avoid
Over-Screening
- Annual screening is not recommended and increases costs and potential harms without significantly improving cancer detection 1
- Screening women under age 21 should be avoided regardless of sexual activity 1, 2
- Continuing screening after age 65 in adequately screened women provides minimal benefit (reduces mortality by only 0.18% at age 65 and 0.06% at age 74) 3, 4
Under-Screening
- Failing to screen high-risk populations such as immunocompromised women or those with previous abnormal results 1
- Not obtaining adequate documentation of screening history before discontinuing screening 4
Common Misunderstandings
- The 3-year interval applies universally for women aged 30-65 with negative co-testing and is considered safe and appropriate 1
- Medicare covers Pap testing at three-year intervals for average-risk women, with yearly screening allowed only for high-risk women or those with abnormal results in the preceding three years 3, 1