What are the recommended intervals for Papanicolaou (Pap) smear screenings?

From the Guidelines

Cervical cancer screening with Pap smears should begin at age 21 and continue until age 65 for most women, with screening intervals of every 3 years with cytology alone for women aged 21-29, and every 5 years with co-testing (cytology plus HPV testing) or every 3 years with cytology alone for women aged 30-65, as recommended by the most recent guidelines 1. The American Cancer Society recommends that women aged 21-29 years should receive cytology screening every 3 years with either conventional cervical cytology smears or liquid-based cytology, and HPV testing should not be used for women in this age group 1. For women aged 30-65 years, the preferred approach is to be screened every 5 years with the combination of HPV testing and cytology (“cotesting”), although it is also acceptable for women to continue to be screened every 3 years with cytology alone 1. Some key points to consider when determining the appropriate screening interval include:

• Women should discontinue screening after age 65 years if they have had 3 consecutive negative cytology tests or 2 consecutive negative cotest results within the 10-year period prior to ceasing screening, with the most recent test occurring within the last 5 years 1.
• Women at any age should NOT be screened annually by any screening method 1.
• Women who have had a total hysterectomy with removal of the cervix for non-cancerous conditions and no history of high-grade precancerous lesions do not need screening 1.
• More frequent screening may be necessary for women with HIV, immunosuppression, DES exposure in utero, or previous treatment for cervical precancer or cancer 1. The US Preventive Services Task Force also recommends screening for cervical cancer in women aged 21 to 65 years with cytology (Papanicolaou smear) every 3 years or, for women aged 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus testing every 5 years 1.

From the Research

Pap Smear Screening Intervals

• The American College of Obstetricians and Gynecologists (ACOG), American Cancer Society (ACS), and U.S. Preventive Services Task Force (USPSTF) recommend that screening by Papanicolau (Pap) test should not be used for women aged <21 years, regardless of initiation of sexual activity, and a screening interval of 3 years should be maintained for women aged 21-30 years 2.
• The USPSTF recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years, and every 3 years with cervical cytology alone, every 5 years with hrHPV testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting) in women aged 30 to 65 years 3.
• For people with current precancer risks of less than 4%, repeat HPV testing is recommended in 1,3, or 5 years depending on 5-year precancer risk, and for people with current precancer risks of 4% through 24%, colposcopy is recommended 4.
• A study found that the addition of an HPV test to the Pap test to screen women in their mid-30s for cervical cancer reduces the incidence of grade 2 or 3 cervical intraepithelial neoplasia or cancer detected by subsequent screening examinations 5.
• Another study showed that all women testing positive for HPV regardless of Pap smear result should be referred to colposcopy, as some cases of high-grade squamous intraepithelial lesion (HSIL) were diagnosed after the second HPV test 6.

Screening Recommendations

• Women aged 21-29 years: screen every 3 years with cervical cytology alone 3.
• Women aged 30-65 years: screen every 3 years with cervical cytology alone, every 5 years with hrHPV testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting) 3.
• Women younger than 21 years: do not screen for cervical cancer 3.
• Women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer: do not screen for cervical cancer 3.

HPV Testing and Colposcopy

• Women who test positive for HPV should be referred to colposcopy, regardless of Pap smear result 6.
• For people with current precancer risks of 4% through 24%, colposcopy is recommended 4.
• For people with current precancer risks of 25% through 59%, management consists of colposcopy with biopsy or excisional treatment 4.