What is the best advice for a patient with regular menstruation and no history of abnormal Pap (Papanicolau) smear results regarding cervical cancer screening?

Cervical Cancer Screening Recommendation

For an average-risk woman with regular menstruation and no history of abnormal Pap smears, screening every 3 years is recommended if she is between ages 21-29, or every 3 years with cytology alone (or every 5 years with co-testing) if she is age 30 or older. 1

Screening Intervals by Age

Ages 21-29 Years

• Screen every 3 years with cytology (Pap test) alone 1
• HPV testing should NOT be used in this age group, even for triage of abnormal results in women under 21 1
• Do not screen more frequently than every 3 years unless there is a history of abnormal results 1

Ages 30-65 Years

• Preferred approach: Cytology plus HPV co-testing every 5 years 1
• Acceptable alternative: Cytology alone every 3 years 1
• Women who prefer less frequent screening can use co-testing every 5 years 1

Ages 65+ Years

• Stop screening if the patient has had 3 consecutive negative cytology results OR 2 consecutive negative co-test results within 10 years, with the most recent test within 5 years 1

Timing Considerations for This Patient

Since her last menstrual period was 5 days ago (meaning she just finished menstruating):

• If using conventional cytology: The test can be performed now, as she is no longer actively menstruating 2
• If using liquid-based cytology: The test can be performed at any time regardless of menstrual cycle 2
• The CDC recommends conventional Pap tests ideally be scheduled 10-20 days after the first day of menses, but can be done once menstruation has stopped 2

Common Pitfalls to Avoid

• Annual screening is overused: Despite guidelines recommending 3-5 year intervals, 55% of American women still undergo annual Pap smears, which is excessive and not evidence-based 3
• Don't confuse pelvic examination with Pap testing: Many women erroneously believe they had a Pap smear when only a pelvic exam was performed 1
• Age matters for screening initiation: Screening should begin at age 21 or 3 years after first sexual intercourse, whichever comes later—not at age 18 1

Answer to Multiple Choice Question

The correct answer is B - Every 5 years is recommended (if using co-testing with HPV and cytology for a woman age 30+), though every 3 years with cytology alone is also acceptable. 1

None of the other options are correct:

• Option A (yearly screening) is excessive and not recommended for average-risk women 1
• Option C (no routine screening) is incorrect unless she is over 65 with adequate prior negative screening 1
• Option D (three negative results and no further screening) is only applicable to women over 65 years old 1