Cervical Cancer Screening Frequency for Average-Risk Women Aged 21-65
For asymptomatic women aged 21-65 with no history of cervical cancer or abnormal Pap smears, screen with cervical cytology (Pap smear) every 3 years for ages 21-29, and either cytology alone every 3 years, high-risk HPV testing alone every 5 years, or cotesting (cytology plus HPV) every 5 years for ages 30-65. 1, 2
Age-Specific Screening Protocols
Women Aged 21-29 Years
- Screen with cervical cytology alone every 3 years 1, 2
- Do not use HPV testing (alone or with cytology) in this age group, as transient HPV infections are extremely common and lead to unnecessary interventions without reducing cancer risk 1, 3
- Annual screening is not recommended for any age group 1
Women Aged 30-65 Years
Three equally acceptable options exist, all providing comparable mortality reduction: 1, 3
- Cervical cytology alone every 3 years 1, 2
- High-risk HPV testing alone every 5 years 1, 2
- Cotesting (cytology plus HPV) every 5 years (preferred option) 1
The cotesting strategy is preferred because it allows for longer screening intervals while maintaining high sensitivity for detecting precancerous lesions 1. HPV testing is more sensitive than cytology alone but less specific, which is why it should not be used as a standalone test in younger women 1.
When to Stop Screening
Discontinue screening at age 65 if adequate prior screening has been documented and the woman is not otherwise at high risk 1, 2
Adequate Prior Screening Defined As:
- Three consecutive negative cytology results OR
- Two consecutive negative HPV tests OR
- Two consecutive negative cotests within the past 10 years, with the most recent test occurring within 5 years 3
Common pitfall: Approximately 20% of cervical cancers are diagnosed after age 65, typically in women who lacked adequate prior screening 3. Always verify adequate screening documentation through medical records review before discontinuing screening 3.
Important Exclusions
These recommendations do NOT apply to women with: 1
- History of high-grade precancerous lesions (CIN 2 or 3) or cervical cancer
- HIV infection or immunocompromised state
- In utero diethylstilbestrol exposure
Women with these risk factors require more frequent screening and should continue for at least 20-25 years after treatment of high-grade lesions, even if this extends past age 65 1, 3.
HPV Vaccination Status
Screen all women according to the same age-based guidelines regardless of HPV vaccination status, as current vaccines do not cover all oncogenic HPV types 1, 3.
Key Clinical Considerations
Cytology Methods
Both liquid-based cytology and conventional Pap smears are acceptable, with no clinically important differences in effectiveness 1. Liquid-based cytology offers the advantage of allowing HPV testing from the same sample 1.
Screening More Frequently Than Recommended
Avoid screening more frequently than recommended intervals 3. Screening every year versus every 3 years improves screening effectiveness by less than 5% while substantially increasing harms, including unnecessary procedures, overtreatment of transient lesions, and potential cervical incompetence leading to preterm labor 1.
Women Who Have Had Hysterectomy
Do not screen women who have had a hysterectomy with removal of the cervix for benign indications 1, 2. However, women who had hysterectomy for cervical cancer require continued vaginal cytology screening for at least 20-25 years post-treatment 3.