Pap Smear Screening Frequency for Healthy Women Ages 21-65
For healthy women aged 21-29 years, perform Pap testing every 3 years; for women aged 30-65 years, the preferred approach is HPV co-testing with Pap test every 5 years, with Pap testing alone every 3 years as an acceptable alternative. 1, 2
Age-Specific Screening Intervals
Women Ages 21-29 Years
- Screen with Pap test alone every 3 years after the initial normal result 3, 1
- Do NOT use HPV testing in this age group for routine screening, as transient HPV infections are common and resolve spontaneously 3, 1
- Annual screening is not recommended for any age group 3
Women Ages 30-65 Years
You have two evidence-based options:
Option 1 (Preferred): HPV co-testing with Pap test every 5 years 3, 1, 2
- This approach provides the highest sensitivity for detecting precancerous lesions 3
- The longer 5-year interval is safe because combined testing is more sensitive than cytology alone 1
Option 2 (Acceptable): Pap test alone every 3 years 3, 1, 2
- Use this if co-testing is not available or not preferred 3
Evidence Supporting These Intervals
The 3-year screening interval is strongly supported by data showing that performing Pap tests every 1-2 years compared to every 3 years improves screening effectiveness by less than 5% 3, 1. This minimal benefit does not justify the increased costs, patient burden, and potential harms from more frequent screening 1.
For women aged 30-65 years with negative co-testing, the 3-year interval can be safely extended to 5 years due to the increased sensitivity of the combined approach 1. The US Preventive Services Task Force gives this an "A" recommendation based on high-certainty evidence 2.
When to Stop Screening
Women over age 65 should discontinue screening if they have adequate prior screening with normal results, defined as either:
- 3 consecutive negative Pap tests, OR
- 2 consecutive negative HPV and Pap co-tests within the past 10 years, with the most recent test within 5 years 1, 4, 2
Special Populations Requiring Different Intervals
Do NOT screen women who have had a hysterectomy with cervix removal for benign reasons (no history of high-grade lesions or cancer) 1, 2
Continue screening beyond standard intervals for:
- Women with history of cervical cancer or high-grade precancerous lesions (continue for at least 20-25 years after treatment, even past age 65) 1, 5
- HIV-positive or immunocompromised women 1, 5
- Women with in utero diethylstilbestrol exposure 5
- Women who cannot document adequate prior screening 5
Common Pitfalls to Avoid
Over-screening is a major problem in clinical practice—studies show that 36% of routinely screened women receive annual Pap tests despite recommendations against this 6. This increases costs and potential harms (unnecessary colposcopies, biopsies, anxiety) without significantly improving cancer detection 1.
Under-screening high-risk populations is equally problematic—approximately 42% of women aged ≥65 years diagnosed with cervical cancer had never been screened 5. Always verify screening history through medical records, not patient self-report, which is often inaccurate 1, 7.
Screening women under age 21 provides no benefit and should never be done, regardless of sexual activity 1, 2.
Medicare Coverage
Medicare covers Pap testing at 3-year intervals for average-risk women, and allows yearly screening for women at high risk of cervical or vaginal cancer or who have had an abnormal Pap smear in the preceding 3 years 3, 1.