Pap Smear Screening Schedule for Women Ages 21-65
For women aged 21-29 years, perform Pap testing alone every 3 years; for women aged 30-65 years, perform co-testing with Pap plus HPV testing every 5 years (preferred) or Pap testing alone every 3 years (acceptable). 1
Age-Specific Screening Protocols
Women Ages 21-29 Years
- Begin screening at age 21 years, regardless of age of sexual debut or other risk factors 1
- Screen every 3 years with conventional or liquid-based Pap test alone 1
- Do NOT use HPV testing in this age group for routine screening, as HPV infections are common and typically transient in younger women 2
- Do NOT screen women under age 21, even if sexually active 2, 3
Women Ages 30-65 Years
- Preferred approach: Co-testing with Pap plus HPV DNA test every 5 years 1, 2
- Acceptable alternative: Pap test alone every 3 years 1
- The 5-year interval with co-testing is supported by the increased sensitivity of the combined approach 2
When to Stop Screening
Women Over Age 65
Discontinue screening if adequate prior negative screening is documented: 1
- ≥3 consecutive negative Pap tests alone within the last 10 years, with the most recent test within the last 5 years, OR
- ≥2 consecutive negative co-tests (Pap plus HPV) within the last 10 years, with the most recent test within the last 5 years
Post-Hysterectomy
- Stop screening if the cervix was removed and there is no history of high-grade precancerous lesions (CIN2 or higher) or cervical cancer 1, 2
Critical Exceptions Requiring Modified Screening
History of Abnormal Results
- Women with history of CIN2, CIN3, or adenocarcinoma in situ must continue screening for at least 20 years after treatment, even if this extends past age 65 4
- Women with lower-grade abnormalities must demonstrate adequate negative screening AFTER resolution before standard cessation criteria apply 4
Immunocompromised Status
- Women with HIV, transplant recipients, or chronic immunosuppression require annual screening indefinitely, regardless of age 5
- These patients are explicitly excluded from standard screening guidelines and should never discontinue screening based on age alone 5
Common Pitfalls to Avoid
- Avoid annual screening in average-risk women, as this increases costs and harms without meaningful benefit 2, 3
- Avoid screening before age 21, as cervical cancer is extremely rare in this age group and screening leads to overtreatment 3
- Avoid discontinuing screening prematurely in women with prior abnormal results or immunosuppression 5, 4
- Avoid using HPV testing alone in women under age 30, as it has poor specificity in this population 2
- Avoid screening after total hysterectomy with cervix removal in women without history of high-grade lesions 1, 2