At what interval should a 47‑year‑old average‑risk woman with a normal Pap smear (and negative high‑risk HPV co‑test if performed) be screened again?

Cervical Cancer Screening Interval for a 47-Year-Old Woman with Normal Pap Smear

A 47-year-old woman with a normal Pap smear should repeat screening in 3 years if cytology alone was performed, or in 5 years if co-testing (Pap plus HPV) was performed. 1, 2, 3

Screening Strategy Based on Test Type

If Co-Testing (Pap + HPV) Was Performed

• Repeat screening in 5 years is the preferred interval when both cytology and high-risk HPV testing are negative. 1, 2, 3
• Co-testing every 5 years provides the longest safe interval between screens and offers superior reassurance compared to cytology alone. 2, 4
• The 5-year cumulative incidence of cervical cancer after a negative co-test is extremely low (3.2 per 100,000 women), supporting the extended interval. 4

If Cytology Alone Was Performed

• Repeat screening in 3 years is required when only a Pap smear was done without HPV testing. 1, 5, 3
• The 3-year interval for cytology alone should not be extended to 5 years, as a negative Pap test alone confers less protection than a negative co-test. 2, 5
• Cytology alone every 3 years remains acceptable but is not the preferred strategy for women aged 30-65 years. 2, 6

Critical Distinction: Do Not Confuse Test Results

Common pitfall: The most frequent error is extending the screening interval to 5 years based solely on a negative Pap test without confirming that HPV testing was also performed. 5

• A single negative Pap test does not qualify for the 5-year interval—this extended interval requires documented negative HPV testing as part of the screening strategy. 5
• If the screening method is uncertain, default to the 3-year interval with cytology alone to avoid under-screening. 1, 5

Alternative: Primary HPV Testing

• If primary HPV testing alone (without cytology) was performed and is negative, the American Cancer Society recommends repeat screening in 5 years as the preferred strategy. 2
• Primary HPV testing provides protection comparable to co-testing and does not require concurrent cytology. 2

Planning for Screening Cessation at Age 65

• To exit screening at age 65, this patient will need either 3 consecutive negative cytology tests or 2 consecutive negative co-tests within the prior 10 years, with the most recent test within 5 years. 1, 2, 6
• She must have no history of high-grade squamous intraepithelial lesions (HSIL), adenocarcinoma in situ, or cervical cancer to discontinue screening at age 65. 1, 6
• Once screening is discontinued after age 65, it should not be resumed for any reason, including a new sexual partner. 2

What Not to Do

• Do not screen more frequently than every 3 years with cytology alone—annual or biennial screening markedly increases colposcopy referrals without meaningful reduction in cancer mortality. 2
• Do not extend the co-testing interval beyond 5 years—evidence does not support longer intervals even though the risk remains very low. 2
• Do not use HPV testing in isolation to triage this patient unless it was part of an FDA-approved primary HPV screening protocol; if HPV was only used as an adjunct to cytology, both results determine the interval. 1, 7