Pap Screening Recommendation for a 37-Year-Old Female
For a 37-year-old average-risk woman, screen with either cytology (Pap test) alone every 3 years OR co-testing (Pap test plus HPV test) every 5 years, with co-testing being the preferred approach. 1, 2, 3
Recommended Screening Options
At age 37, this patient falls into the 30-65 year age group where two evidence-based strategies are available:
Preferred: Co-testing every 5 years - Combined Pap test and HPV DNA testing provides the highest sensitivity for detecting precancerous lesions and allows for the safely extended 5-year interval 2, 4, 5
Acceptable alternative: Cytology alone every 3 years - Pap test without HPV testing remains an effective option with substantial reduction in cervical cancer incidence and mortality 1, 3
Emerging option: Primary HPV testing alone every 5 years - The USPSTF 2018 update added this as an equivalent option, though it is less commonly implemented in U.S. practice 3
Why Co-Testing is Preferred at This Age
The combination of Pap and HPV testing every 5 years offers comparable benefits to cytology alone every 3 years, with the advantage of less frequent screening. 1, 2 The increased sensitivity of co-testing (96-100% for detecting CIN 2/3 and cancer) justifies the extended interval 4, 6. HPV testing is specifically recommended for women 30 and older because HPV prevalence decreases with age (from 30% in women 21-24 years to 12% in women 30-34 years), making positive results more clinically meaningful 1, 6.
Critical Pitfall to Avoid
Do not screen annually. Despite clear guidelines, only 19-31% of physicians recommend guideline-concordant intervals, with most continuing annual screening 4. Annual screening provides less than 5% improvement in effectiveness compared to 3-year intervals but substantially increases costs and harms including unnecessary colposcopies, biopsies, and treatments 5, 1. Among routinely screened women in health plans, 36% receive annual screening when it provides minimal additional benefit 7.
Exceptions Requiring Different Screening
This patient should NOT follow these standard recommendations if she has any of the following high-risk factors:
History of CIN 2, CIN 3, or cervical cancer - Requires annual screening for at least 20 years after treatment, even beyond age 65 1, 4
HIV infection or immunocompromised status - Requires more frequent screening, typically annually 1, 4
In utero diethylstilbestrol exposure - Requires continued screening beyond standard intervals 1, 2
History of inadequate screening - May need more frequent initial screening to establish adequate negative results 1
When to Stop Screening
Screening can be discontinued at age 65 if she has adequate prior screening: either 3 consecutive negative Pap tests OR 2 consecutive negative co-tests within the past 10 years, with the most recent test within 5 years, and no history of high-grade lesions 4, 5, 3. Women with prior abnormalities must continue screening for 20-25 years after treatment regardless of age 4, 5.
HPV Vaccination Status
Even if this patient received HPV vaccination, she still requires routine screening because the vaccine does not protect against all oncogenic HPV types 1. Screening recommendations do not change based on vaccination status 8.