What is the recommended frequency for a Papanicolaou (Pap) smear?

From the Guidelines

Women between the ages of 21 and 29 should undergo a Pap smear every 3 years, while those between 30 and 65 years old should have a Pap smear with human papillomavirus (HPV) testing every 5 years, or a Pap smear alone every 3 years 1.

Key Recommendations

• Women under 21 years old should not be screened for cervical cancer 1.
• Women over 65 years old who have had adequate prior screening and are not at high risk for cervical cancer may discontinue Pap smear screening 1.
• Women who have undergone a hysterectomy with removal of the cervix and have no history of cervical cancer or high-grade cervical dysplasia may also discontinue screening 1.

Screening Intervals

• The preferred approach for women aged 30 to 65 years is cotesting every 5 years with cytology and HPV testing 1.
• It is also acceptable for women to continue to be screened every 3 years with cytology alone 1. The American Cancer Society and the US Preventive Services Task Force recommend these screening guidelines to balance the benefits and harms of cervical cancer screening 1.

From the Research

Recommended Frequency for Papanicolaou (Pap) Smear

The recommended frequency for a Papanicolaou (Pap) smear varies based on age and other factors, as outlined in the following points:

• For women aged 21 to 29 years, the US Preventive Services Task Force (USPSTF) recommends screening every 3 years with cervical cytology alone 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 both tests (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 for indications other than a high-grade precancerous lesion or cervical cancer 2.

Trends in Pap Smear Screening

Studies have shown that:

• There has been a decline in Pap completion rates over time in all age groups, including an unexpected decline in 21- to 29-year-old women 3.
• Pap-HPV cotesting has significantly increased among women aged 30-65 years, from 10.0% in 2007 to 60.8% in 2016 3.
• The majority of American women report being screened for cervical cancer more frequently than recommended, with 55% undergoing Pap smear screening annually and 17% reporting a 2-year screening interval 4.

Barriers to Cervical Cancer Screening

Research has identified barriers to cervical cancer screening, including:

• Foreign-born women being less likely to have received a Pap smear compared with US-born women 5.
• Women's hesitancy to undergo less frequent cervical cancer screening, with concerns about developing cancer between screenings being a primary concern 6.