A Pap smear is used to screen for cervical cancer. The Pap smear is usually done in conjunction with a pelvic exam. In women older than age 30, the Pap smear may be combined with a test for human papillomavirus (HPV) — a common sexually transmitted infection that can cause cervical cancer in some women.

Who should have a Pap smear?

You and your doctor can decide when it's time for you to begin Pap smear testing and how often you should have the test. In general, doctors recommend beginning Pap smear testing at age 21 and then every two or three years. After age 30, Pap smears are generally recommended every three years, or every five years when the Pap smear is combined with an HPV test.

If you have certain risk factors, your doctor may recommend more-frequent Pap smears, regardless of your age. These risk factors include:

  • A diagnosis of cervical cancer or a Pap smear that showed precancerous cells
  • Exposure to diethylstilbestrol (DES) before birth
  • HIV infection
  • Weakened immune system due to organ transplant, chemotherapy or chronic corticosteroid use

You and your doctor can discuss the benefits and risks of Pap smears and decide what's best for you based on your risk factors.

What do medical organizations recommend?

A number of organizations have recommendations regarding when and how frequently a woman should have Pap smears. These guidelines differ slightly because each organization takes different factors into consideration. The guidelines are recommendations for you and your doctor to consider and discuss.

In general, groups agree that you should have your first Pap smear at age 21:

  • The American Cancer Society (ACS) recommends having your first Pap smear at age 21.
  • The American Congress of Obstetricians and Gynecologists (ACOG) recommends having your first Pap smear at age 21.
  • The U.S. Preventive Services Task Force (USPSTF) recommends that women begin Pap smear testing at age 21.
  • The Institute for Clinical Systems Improvement (ICSI) recommends that women begin Pap smear testing at age 21.

Groups' guidelines differ for how often the tests should be done.

Age ACS ACOG USPSTF ICSI
21 - 29 Every 3 years Every 3 years Every 3 years Every 2 years
30 and older Every 3 years, or every 5 years when Pap smear is combined with an HPV test — women at high risk may need to be screened more often Every 3 years, or every 5 years when Pap smear is combined with an HPV test — women at high risk may need to be screened more often Every 3 years, or every 5 years when Pap smear is combined with an HPV test Every 3 years if you've had 3 negative tests in a row

Who can consider stopping Pap smears?

Discuss your screening options with your doctor. In certain situations a woman and her doctor may decide to end Pap testing, such as:

  • After total hysterectomy. After a total hysterectomy — surgical removal of the uterus including the cervix — ask your doctor if you need to continue having Pap smears. If your hysterectomy was performed for a noncancerous condition, such as uterine fibroids, you may be able to discontinue routine Pap smears. But if your hysterectomy was for a precancerous or cancerous condition of the cervix, your doctor may recommend continuing routine Pap smears.
  • Older age. Groups agree that older women may consider stopping routine Pap tests. ACS guidelines suggest a woman older than age 65 can stop having tests if she's had regular screenings with normal results. USPSTF guidelines recommend against Pap testing for women older than age 65 who have had routine Pap testing in the past and are not at high risk of cervical cancer. ICSI guidelines recommend women ages 65 to 70 may consider stopping Pap testing if their last three tests have been negative and they've had no abnormal tests in 10 years. ACOG guidelines say that women older than age 65 can stop Pap tests if they've had three consecutive negative Pap tests in the last 10 years, or two consecutive negative Pap tests combined with negative HPV tests in the last 10 years, with the most recent test performed within the past 5 years. Discuss your options with your doctor and together you can decide what's best for you based on your risk factors. If you are sexually active with multiple partners, your doctor may recommend continuing Pap smear testing.
Oct. 31, 2012