Screening Interval for ThinPrep Pap with HPV Co-Testing
A negative ThinPrep Pap test combined with negative high-risk HPV testing provides protection for 5 years in average-risk women aged 30-65 years. 1
Standard Screening Intervals by Age
Women Aged 30-65 Years
Co-testing (Pap + HPV) every 5 years is the preferred strategy for this age group, offering the longest safe interval between screens. 1
Cytology alone every 3 years remains acceptable but is not preferred, as it requires more frequent screening and provides less reassurance than co-testing. 1
The 5-year interval for co-testing is supported by evidence showing that adding HPV testing to cytology increases detection of prevalent high-grade lesions (CIN3+) while decreasing detection in subsequent screening rounds, translating to lower risk after a negative screen. 1
Women Aged 21-29 Years
- Cytology alone every 3 years is recommended; HPV testing should not be used in this age group either as standalone or co-testing. 1
Critical Exception: HPV-Negative with ASC-US
If your result shows HPV-negative but ASC-US cytology (atypical squamous cells of undetermined significance), return in 3 years, not 5 years. 2, 3, 4
This discordant result carries higher risk than a completely negative co-test, with 5-year CIN3+ risk of 0.48% compared to 0.11% for negative co-testing. 4
The risk profile of HPV-negative/ASC-US aligns more closely with negative cytology alone (0.31% CIN3+ risk) than with negative co-testing. 4
This result is insufficient for exiting screening at age 65 and requires the standard 3-year follow-up interval. 2, 3
Requirements for Discontinuing Screening at Age 65
To stop screening at age 65, you must meet all of the following criteria: 1, 2, 5
- Either 3 consecutive negative cytology tests OR 2 consecutive negative co-tests within the past 10 years
- The most recent test must have occurred within the past 5 years
- No history of CIN2, CIN3, adenocarcinoma in situ, or cervical cancer
- No history of high-grade squamous intraepithelial lesion (HSIL)
Once screening is discontinued after age 65, it should not resume for any reason, including a new sexual partner. 1
Extended Surveillance for High-Risk History
Women with a history of CIN2 or higher must continue routine screening for at least 20 years beyond the initial diagnosis, even if this extends screening past age 65. 1, 2
After treatment for high-grade precancer, testing occurs at 6,18, and 30 months, followed by 3-year intervals for at least 25 years. 2
Evolution to Primary HPV Testing
The American Cancer Society (2020) now recommends primary HPV testing every 5 years as the preferred strategy for women aged 25-65, without requiring concurrent cytology. 2
Co-testing every 5 years or cytology alone every 3 years are acceptable only where FDA-approved primary HPV testing is unavailable and should be phased out. 2
After successive negative primary HPV tests, the 5-year risk of CIN3+ declines to approximately 0.073% after the first negative, 0.042% after two negatives, and 0.027% after three negatives. 2
An HPV-negative result provides protection comparable to a negative co-test, regardless of accompanying cytology. 2
Common Pitfalls to Avoid
Do not extend the interval beyond 5 years for routine co-testing, even with multiple prior negative results—there is insufficient evidence to support longer intervals. 1, 2
Do not confuse negative co-test results with HPV-negative/ASC-US results, which require 3-year rather than 5-year follow-up. 2, 3, 4
Do not screen more frequently than every 3 years with cytology alone, as annual or biennial screening doubles to triples the number of colposcopies without meaningful reduction in cancer risk (predicted lifetime cancer death: 0.03 per 1000 for annual vs. 0.05 per 1000 for every 3 years). 1
Do not allow women with recent abnormal results to exit screening at age 65 without obtaining the required consecutive negative tests. 3, 5
Special Populations Excluded from Standard Intervals
These recommendations apply only to average-risk women and do not apply to: 1, 2
- Women with history of cervical cancer
- Women exposed in utero to diethylstilbestrol (DES)
- Immunocompromised women (HIV-positive, organ transplant recipients, chronic corticosteroid users, chemotherapy patients)
- Women with history of CIN2 or higher (require extended surveillance)