Pap Smear Screening Guidelines

No single aspect of my practice has changed more in the past decade than the technology of screening for cervical cancer, the terminology of the results, and the timing of those tests.

Women have become accustomed to having their pap tests done annually since the mid 20th century. With newer and better tests available, the recommendations regarding when a woman should start having pap tests performed, how often they should be performed, and when they should no longer be performed have changed dramatically.

The most recent guidelines from the American College of Obstetricians and Gynecologists are as follows:

  • Pap testing starting no earlier than 21 years old
  • Ages 21-29
    Pap testing every 2 years if normal
  • Ages 30-65
    If a woman has had 3 normal pap tests or a normal pap test with a negative screen result for the high risk forms of the human papilloma virus (HPV/the virus series that causes cervical cancer and cervical pre-cancer), then Pap tests should be performed every 3 years.
  • Over age 65
    No further Pap testing is needed if there have been three normal pap tests in a row and if there have been no significantly abnormal pap tests within 10 years.
  • For women who have had hysterectomies (uterus and cervix removal).  If the hysterectomy was done for reasons other than cervical cancer or pre-cancer, then pap tests may be discontinued.

Of course there are always exceptions to rules.  If a woman has a compromised immune system due to an organ transplant, chemotherapy, or steroid use, she may need more frequent testing.  If a woman’s mother was exposed the medication diethylstilbesterol (DES) while she was pregnant more frequent testing is indicated as well.  Finally, HIV positive women are at higher risk for cervical cancer and should have more frequent pap tests.

While these are the most current guidelines in the United States, many providers still have not adopted them.  We encourage women to engage in a discussion with their healthcare providers to determine what protocols are being used within their offices.

Below are two helpful links to further explain the pap test itself as well as the current guidelines:

ACOG – Pap Test FAQ

National Cancer Institute FactSheet – Pap Test

While the pap screening guidelines have changed, it is very important to remember that a preventive maintenence or “well-woman” exam is recommended yearly!

Still have questions? E-mail us via the well-woman or “Contact Us” link, or come see us in the office!

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