Do I need to get an annual Pap smear?

Comedian Kathy Griffin gets a public pap smear on camera in order to promote women's health awareness at the Palomar Hotel on April 16, 2010 in Westwood, California. (Photo by Angela Weiss/Getty Images). Photo: Angela Weiss/Getty Images

If you're a person with a cervix who is over the age of approximately 25, you may have grown up thinking that you needed to have an annual Pap smear. It was considered to be such an important annual test that some doctors even used birth control pills as a bribe to get women into the chair. Unfortunately, now that doctors have realized that it's possible to over test using the Pap smear, and have reduced recommended screening frequently accordingly, the push-back has changed.

Instead of wanting fewer Pap smears in their lives, some people with cervices are actually pushing for more!

However, science has pretty conclusively shown that yearly Pap smears aren't necessary for most women, particularly when combined with appropriate HPV testing. It's rare that all the professional societies agree on testing guidelines, but there is a clear consensus amongst the experts that yearly Pap smears are too much of a good thing. Testing more frequently than the guidelines recommend isn't helpful, and it can be harmful if it leads to unnecessary biopsies or other procedures. Therefore, people shouldn't push their doctors to give them Pap smears them more often than the guidelines suggest, even if it feel strange to wait three years between tests.

Spacing out Pap smears makes sense, because the vast majority of cervical cancers are caused by HPV, and it's usually not an incredibly speedy process for an infection to become pre-cancerous or cancerous.

(There are exceptions, and these fast growing cancers are often the most difficult to treat.) The truth is that even most high risk HPV infections go away on their own within two years, as do many early pre-cancerous lesions. Therefore, it's primarily those individuals who repeatedly test positive for high-risk forms of HPV who should be concerned about cancer risk and, as more and more young women are getting vaccinated against the most common high-risk forms of the human papillomavirus, these infections will become less and less prevalent.

Pap smears will still be necessary, since the vaccines aren't 100% protective and not every woman will be vaccinated, but cervical dysplasia will become less and less common.

Interestingly, I think we are moving towards a day when the question about Pap smears isn't how often we give them, or how early we start (waiting until older ages is going to make increasingly more sense as vaccine coverage increases), but how late we stop. In June of 2015, British scientists published a paper suggesting that by stopping Pap smears after age 65, doctors may be missing the chance to help people who are still at significant risk. Sex doesn't stop when you get older, and neither does the risk of STDs or their consequences -- like cancer.


Katki HA, Schiffman M, Castle PE, Fetterman B, Poitras NE, Lorey T, Cheung LC, Raine-Bennett T, Gage JC, Kinney WK. (2013) Five-year risks of CIN 3+ and cervical cancer among women who test Pap-negative but are HPV-positive. J Low Genit Tract Dis. 17(5 Suppl 1):S56-63. doi: 10.1097/LGT.0b013e318285437b.

Rebolj M, van Ballegooijen M, van Kemenade F, Looman C, Boer R, Habbema JD. (2008) No increased risk for cervical cancer after a broader definition of a negative Pap smear. Int J Cancer. 123(11):2632-5. doi: 10.1002/ijc.23803.

Sherman, S. M., Castanon, A., Moss, E., Redman, C.W. E. (2015) Cervical cancer is not just a young woman’s disease BMJ 2015; 350 :h2729

United States Preventative Services Task Force. (2012) Cervical Cancer: Screening. Accessed 6/16/15 at

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