From the Guidelines
Pap smear screening should begin at age 21 regardless of sexual history, with testing every 3 years until age 30, as recommended by the most recent guidelines 1. From ages 30-65, women can either continue Pap tests every 3 years, get HPV testing alone every 5 years, or have co-testing (Pap plus HPV) every 5 years. Screening can stop after age 65 if there's a history of adequate negative screening and no high-risk factors. Some key points to consider include:
- Women who have had a total hysterectomy (including cervix removal) for non-cancerous reasons can discontinue screening.
- Those with a history of cervical cancer, HIV, immunosuppression, or DES exposure may need more frequent screening.
- During the procedure, cells are collected from the cervix using a small brush and spatula, which typically causes minimal discomfort.
- Patients should avoid douching, sexual intercourse, and vaginal medications for 24-48 hours before the test to ensure accurate results. These guidelines balance the benefits of early detection against the risks of overscreening, as most HPV infections clear naturally and excessive testing can lead to unnecessary procedures, as noted in the guidelines 1. The American Cancer Society and other organizations have issued joint guidelines for cervical cancer screening, which 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. However, the most recent and highest quality study should be prioritized when making a definitive recommendation, which in this case is the 2016 guideline 1.
From the Research
Pap Smear Guidelines
- The US Preventive Services Task Force recommends cervical cytology screening once every 3 years for women between 21 and 29 years old, and against testing women younger than 21 years regardless of sexual history 2.
- A study found that the cervical cancer screening guidelines introduced in 2012 have not had a detrimental impact on the outcomes of cervical cancer screening for 21- to 25-year-old women, but continued monitoring is needed for 26- to 29-year-old women 2.
- Human papillomavirus (HPV) testing is recommended as a follow-up after loop electrosurgical excision procedure (LEEP) to identify women at risk for posttreatment cervical intraepithelial neoplasia grade 2 or 3 disease 3, 4, 5.
- The American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines recommend colposcopy for women with abnormal cytology, positive high-risk HPV testing, or diagnosed cervical intraepithelial neoplasia (CIN) 6.
- Primary care clinicians should offer HPV vaccination to all patients between the ages of nine and 26, in addition to cervical cancer screening and follow-up guidance 6.
- Long-term surveillance is recommended for patients with CIN 2 or worse, and patients with an abnormal cervical cancer screening history require surveillance that differs from routine screening for patients with normal prior screening results 6.
Screening Frequency
- Women between 21 and 29 years old should be screened every 3 years 2.
- Women who have undergone LEEP should have follow-up screening with combined cytology and HPV testing 4.
- Women with a history of CIN 2 or worse should have long-term surveillance 6.
HPV Testing
- HPV testing is recommended as a follow-up after LEEP to identify women at risk for posttreatment CIN 2 or 3 disease 3, 4, 5.
- HPV testing can be used in combination with cytology to identify women at risk for CIN 2 or 3 disease 5.
- HPV vaccination is recommended for all patients between the ages of nine and 26 6.