What are the guidelines for Pap (Papanicolaou) smears?

From the Guidelines

Pap smears are recommended for cervical cancer screening in women starting at age 21, regardless of sexual activity, with a screening interval of every 3 years for women aged 21-29 years and every 5 years with co-testing (Pap test and HPV testing) for women aged 30-65 years. The screening guidelines recommend different surveillance strategies and options based on a woman’s age, her screening history, other risk factors, and the choice of screening tests 1.

Key Recommendations

• Women aged 21 to 29 years should receive cytology screening (with either conventional cervical cytology smears or liquid-based cytology) every 3 years, and HPV testing should not be used for women in this age group 1.
• For women aged 30 to 65 years, the preferred approach is to be screened every 5 years with the combination of HPV testing and cytology (“cotesting”), although it is also acceptable for women to continue to be screened every 3 years with cytology alone 1.
• Women should discontinue screening after age 65 years if they have had 3 consecutive negative cytology tests or 2 consecutive negative cotest results within the 10-year period prior to ceasing screening, with the most recent test occurring within the last 5 years 1.
• Women at any age should NOT be screened annually by any screening method 1.

Special Considerations

• Women who have had a total hysterectomy (including removal of the cervix) for non-cancerous reasons can also discontinue screening 1.
• However, women with a history of cervical cancer, high-grade precancerous lesions, or HIV should continue screening as directed by their healthcare provider.
• Pregnant women can follow routine screening guidelines. Pap smears involve collecting cells from the cervix during a pelvic examination, which are then examined for abnormalities that might indicate cancer or precancerous changes. This screening is effective because cervical cancer typically develops slowly, allowing for detection and treatment of precancerous changes before they become invasive cancer.

From the Research

Guidelines for Pap Smears

• The US Preventive Services Task Force (USPSTF) recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years 2.
• For women aged 30 to 65 years, the USPSTF recommends screening every 3 years with cervical cytology alone, every 5 years with hrHPV testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting) 2.
• The USPSTF recommends against screening for cervical cancer in women younger than 21 years, women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer, and women who have had a hysterectomy with removal of the cervix and do not have a history of a high-grade precancerous lesion or cervical cancer 2.
• A study on cervical cancer screening using Pap smear test and clinical correlation found that a Pap smear is simple, noninvasive, cost-effective, and easy to perform for detection of precancerous lesions in a gynecological patient 3.
• Another study compared conventional Pap smear test, liquid-based cytology, and human papillomavirus testing as stand-alone or cotesting strategies for cervical cancer screening, and found that cotesting offers no benefit in detection over stand-alone HPV testing, resulting in more false positive results and colposcopy referrals 4.
• A comparison of HPV test versus conventional and automation-assisted Pap screening as potential screening tools for preventing cervical cancer found that the HPV test had a higher sensitivity than conventional Pap smear screening, but a lower specificity 5.

Screening Intervals and Methods

• The USPSTF recommends screening every 3 years with cervical cytology alone in women aged 21 to 29 years, and every 3 years with cervical cytology alone, every 5 years with hrHPV testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting) in women aged 30 to 65 years 2.
• A study found that cotesting with Pap smear and HPV testing had a higher sensitivity than stand-alone HPV testing, but a lower specificity 4.
• Another study found that the HPV test had a higher sensitivity than conventional Pap smear screening, but a lower specificity 5.

Special Considerations

• Women who have had a hysterectomy with removal of the cervix and do not have a history of a high-grade precancerous lesion or cervical cancer do not need to undergo cervical cancer screening 2.
• Women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer do not need to undergo cervical cancer screening 2.
• Women younger than 21 years do not need to undergo cervical cancer screening 2.