Cervical Cancer Screening Schedule for a Woman with Last Normal Pap in [YEAR]
For women aged 21-29 years, continue screening with Pap test alone every 3 years; for women aged 30-65 years, the preferred approach is HPV co-testing with Pap test every 5 years (or Pap test alone every 3 years as an acceptable alternative); women over age 65 with adequate prior screening should discontinue screening. 1, 2
Screening Algorithm by Age Group
Women Aged 21-29 Years
- Screen with Pap test alone every 3 years after the initial normal result 3, 1, 2
- HPV testing should NOT be used in this age group for routine screening 1
- If using liquid-based cytology, the 3-year interval applies; conventional Pap smears require annual screening until three consecutive normal results are obtained 1
Women Aged 30-65 Years
Preferred Option:
- HPV co-testing (Pap test plus HPV DNA test) every 5 years provides the highest sensitivity for detecting precancerous lesions 3, 1, 2
Acceptable Alternative:
The evidence strongly supports these intervals: performing Pap tests every 1-2 years compared to every 3 years improves screening effectiveness by less than 5%, making more frequent screening inefficient 1, 2. The addition of HPV testing allows for the safe extension to 5-year intervals due to increased sensitivity 1.
Women Over Age 65
Discontinue screening if adequate prior screening is documented: 3, 1, 4
- 3 consecutive negative Pap tests within the past 10 years, with the most recent test within 5 years, OR
- 2 consecutive negative HPV and Pap co-tests within the past 10 years, with the most recent test within 5 years
Once screening is discontinued, it should not resume for any reason, even if a woman reports having a new sexual partner 4
Critical Exceptions Requiring Continued or More Frequent Screening
High-Risk Populations (Continue Beyond Standard Intervals)
- History of CIN2, CIN3, or adenocarcinoma in situ: Continue routine screening for at least 20 years after treatment, even if this extends screening past age 65 4, 2
- HIV-positive or immunocompromised women require more frequent screening 1, 2
- History of cervical cancer requires continued surveillance 2
- In utero diethylstilbestrol exposure 2
- Multiple sexual partners, smoking, or pessary use 4
Women Who Have Never Been Screened
- Regardless of age, obtain at least 2 negative Pap smears 1 year apart before adopting standard screening intervals 1, 4
- This is particularly important as unscreened women have an incidence of disease 3-4 times higher than those with at least one prior normal Pap smear 4
Women Who Should Stop Screening
Post-Hysterectomy
Discontinue screening if: 3, 1
- Cervix was removed, AND
- No history of high-grade precancerous lesions or cervical cancer
Adequate Prior Screening Documentation
If documentation of recent screening cannot be obtained, perform screening tests until the criteria for cessation are met 4
Common Pitfalls to Avoid
Over-screening: Annual Pap tests provide minimal additional benefit (less than 5% improvement) while significantly increasing costs, false-positives, and unnecessary procedures 1, 2
Under-screening high-risk populations: Women with previous abnormal results, immunocompromised status, or HIV infection require continued surveillance beyond standard intervals 1
Premature discontinuation: Do not stop screening before age 65 without documented adequate prior screening, and never stop screening in women with a history of high-grade lesions within the past 20 years 4
Screening after appropriate hysterectomy: This is unnecessary and wasteful in women who have had their cervix removed for benign reasons 3, 1
Medicare Coverage
Medicare covers Pap testing and pelvic examinations at 3-year intervals for average-risk women, with yearly screening allowed for high-risk women or those with an abnormal Pap smear in the preceding 3 years 1, 2