From the Guidelines
Pap smear screening should begin at age 21 regardless of sexual history, with different intervals based on age and risk factors. For women aged 21-29, screening should occur every 3 years with cytology alone, as HPV testing should not be used for women in this age group 1. Women aged 30-65 have options for screening, including cytology every 3 years, or co-testing (cytology plus HPV testing) every 5 years 1.
Key Recommendations
- Women younger than 21 years should not be screened regardless of their age of sexual initiation 1.
- Women at any age should not be screened annually by any screening method 1.
- Screening can be discontinued after age 65 if there is adequate prior negative screening (at least three consecutive negative cytology results or two consecutive negative co-tests within the past 10 years, with the most recent test within the past 5 years) 1.
Rationale
These guidelines are based on understanding that cervical cancer develops slowly from persistent HPV infection, and that most HPV infections clear spontaneously, particularly in younger women 1. The intervals balance the benefits of early detection against the harms of overtreatment for transient abnormalities. The American Cancer Society (ACS) continues to monitor and update guidelines as new evidence emerges, including the use of HPV DNA testing for primary cervical cancer screening 1.
From the Research
Pap Smear Guidelines
- 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, as it does not provide significant benefit 2.
- Screening is also not recommended for women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer, as well as women who have had a hysterectomy with removal of the cervix for indications other than a high-grade precancerous lesion or cervical cancer 2.
Screening Benefits and Harms
- Screening women aged 21 to 65 years substantially reduces cervical cancer incidence and mortality 2.
- The harms of screening for cervical cancer in women aged 30 to 65 years are moderate 2.
- The USPSTF concludes with high certainty that the benefits of screening outweigh the harms for women aged 21 to 65 years 2.