Recommended frequency of Pap tests

The Pap test is the most effective screening test for cervical cancer and is often part of a pelvic exam. Testing should start within 3 years of a woman beginning sexual intercourse, whatever age that may be, but no later than 21 years of age. The U.S. Preventive Services Task Force (USPSTF) strongly recommends screening for cervical cancer in women who have been sexually active and have a cervix.¹

The American Cancer Society recommends the following screening schedule.²

• Women younger than 30 should have yearly conventional Pap tests. Every 2 years is recommended if liquid-based collection is used.
• Women older than 30 should have different screening recommendations based on their risk factors.
• Women with a history of three normal Pap tests in a row may be screened every 2 to 3 years with conventional or liquid-based Pap tests.
• Women with a normal Pap test and a human papillomavirus (HPV) test that is negative for a high-risk HPV type should be screened every 3 years. More often than every 3 years is not necessary because these women are at very low risk for abnormal cervical cell changes.
• Women with the following risk factors may require more frequent screening.
  • Exposure to diethylstilbestrol (DES) before birth (prenatal exposure). Between 1948 and 1971, millions of women took a drug called diethylstilbestrol (DES) to prevent miscarriage. Daughters born to women who took DES while pregnant have a slightly higher risk of developing abnormal cervical cells and cancer of the vagina.
  • Infection with human immunodeficiency virus (HIV). Women infected with HIV should have screening twice in the first year after being diagnosed with HIV and yearly after that.
  • A history of being treated for abnormal cervical cell changes or cervical cancer. Women with a history of moderate to severe cervical cell changes remain at risk for persistent or recurrent disease and should continue yearly screening.
  • An impaired immune system, such as in those receiving chemotherapy. These women are at higher risk for having abnormal Pap tests and developing cervical cancer because the immune system is not able to fight abnormal cell changes. Any abnormal Pap test should be followed by colposcopy and appropriate treatment.

Females who get the HPV vaccine(What is a PDF document?) should get screened for cervical cancer on the same schedule as everyone else.³

Women ages 65 to 70

Experts agree that women who have had three normal Pap test results in the past 10 years may decide to stop screening after ages 65 to 70. You and your health professional can decide on the appropriate age to stop based on your medical history. Some risk factors that you will want to consider include:¹

• Being sexually active with multiple partners.
• Having a history of abnormal cervical cell changes.
• Having a Pap test that is positive for HPV.

Women who have had a hysterectomy

A hysterectomy is a surgical procedure in which the entire uterus is removed, usually including the cervix. Occasionally the cervix may be left intact (supracervical hysterectomy). You and your health professional can decide on the appropriate interval based on your medical history.

• Women without a cervix
  • Pap testing does not need to continue if the cervix was removed for noncancerous reasons.
  • Regular Pap testing should continue if the cervix was removed for precancerous changes but may be stopped after 3 normal Pap tests if you do not have any other continuing risk factors for cell changes (dysplasia).
  • Regular Pap testing should continue if the cervix was removed for cervical cancer.
• Women with a cervix
  • Regular Pap testing should continue until age 65 to 70 if the uterus has been removed but the cervix is still present. If a woman is unsure whether she still has her cervix, her health professional should do a gynecologic examination to determine whether the cervix is still present.

Women who have gone through menopause have an increased risk of false-positive Pap test results. For this reason, postmenopausal women with previous normal Pap tests may be advised to have Pap tests less frequently than every year.⁴

After any abnormal Pap test, your health professional will recommend follow-up to monitor the cell changes.

Cervical cells can be collected by several different methods during a Pap test. Some experts believe that the type of collection method can help determine how often screening should occur. Research on these collection methods continues.

For more information, see the topics Abnormal Pap Test, Cervical Cancer, and Pap Test.

Citations

1. U.S. Preventive Services Task Force (2003). Screening for cervical cancer: Summary of recommendations. Available online: http://www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.pdf.

2. Saslow D, et al. (2002). American Cancer Society guideline for the early detection of cervical neoplasia and cancer. CA: A Cancer Journal for Clinicians, 52(6): 342–362.

3. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (2007). Quadrivalent human papillomavirus vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 56(RR–2): 1–24. Also available online: http://www.cdc.gov/mmwr/PDF/rr/rr5602.pdf.

4. Sawaya GF, et al. (2000). The positive predictive value of cervical smears in previously screened postmenopausal women: The Heart and Estrogen/progestin Replacement Study (HERS). Annals of Internal Medicine, 133(12): 942–950.

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