Do You Need A Yearly Pap Smear?

Examining the case against yearly Pap smears in healthy adults.

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Nobody likes to get a Pap smear. The mere mention of a Pap smear (Pap test) is enough to dampen any woman's mood and brings to mind paper drapes, a bright overhead light, stirrups and, of course, a cold steel speculum. However, these tests are a medical necessity and a most effective weapon in the battle against cervical cancer.

For nearly six decades, many physicians recommended that all their patients get yearly Pap smears.

In 2012, however, both the American Cancer Society and the United States Preventive Services Task Force (USPSTF) deemed yearly Paps excessive, and instead recommended that healthy women receive Pap smears every three years.

Understanding Pap Smears

The cervix lies between the vagina and uterus and is a common site of cancer. A Papanicolaou smear (Pap smear) is a screening test used to detect cellular changes (dysplasia) in the uterine cervix indicative of cervical cancer. Specifically, a Pap smear is used to examine cells located in the squamocolumnar junction (transformation zone) where the cells of the vagina transition into the cells of the uterus.

Here are the possible results of a Pap smear:

  • normal Pap smear
  • ASCUS or AGUS indicating the presence of atypical cells of uncertain significance that could be due to HPV (genital warts) and lead to cervical cancer
  • LSIL (low-grade dysplasia) indicating cellular changes that could lead to cancer
  • HSIL (high-grade dysplasia) indicating changes that are even more likely than LSIL to lead to cancer
  • Atypical squamous cells (ASC) or atypical glandular cells (AGC) that could lead to cancer
  • Carcinoma in situ or cervical cancer

If findings of your Pap smear are anything but normal, you'll need a colposcopy, which entails a more detailed examination of your cervix for evidence of cancer.

Additionally, if your Pap smear yields abnormal results, you'll also need to be screened for HPV or genital warts, which are by far the most common cause of cervical cancer.

Of note, although a primary care physician or OB-GYN can perform a Pap smear, an OB-GYN performs a colposcopy.

New Guidelines Regarding Pap Smears

It should be noted that the new guidelines regarding Pap smear screening apply only to women who are healthy and have normal Pap smear results.

Here are the new guidelines in a nutshell:

  • Women aged between 21 and 65 should receive Pap screens every 3 years.
  • Women aged 21 and younger should not be screened regardless of previous sexual history.
  • Women aged 65 and older should not be screened.
  • Women who are aged between 30 and 65 years can lengthen the interval between Pap smears to 5 years after receiving normal Pap smear results and testing negative for HPV.
  • Women aged 30 years and younger shouldn't be tested for HPV.

Before new guidelines regarding Pap smear screening were issued in 2012, guidelines issued in 2003 recommended that women start receiving Pap smears within three years of first sexual activity regardless of age. Furthermore, previous guidelines failed to provide firm guidance as to whether Pap smears should be performed in intervals fewer than three years, which is why many physicians were screening healthy patients every year (and many women were requesting to be screened every year).

Finally, the 2003 guidelines did not provide guidance on whether HPV screening was required in women.

These new guidelines loosen recommendations on both Pap testing and HPV testing in healthy women because previously too many women were getting false positive results that raised undue concern about the risk of developing cervical cancer. Such unwarranted concerns resulted in an increased number of painful biopsies and increased a woman's risk for preterm labor and low-birth weight infants resulting from colposcopy. Furthermore, many women younger than 30 years old have HPV that is transient and eventually cleared from their systems without consequence.

Ultimately, if you or a person you love is aged between 21 to 65 years old, Pap smears are still a necessity. However, as long as you're healthy, there's no need to receive yearly testing. More frequent testing confers no additional benefit and may increase your risk of unneeded interventions and consequences related to more invasive testing like colposcopy.


Usatine RP, Smith MA, Chumley HS, Mayeaux EJ, Jr. Chapter 88. Colposcopy—Normal and Noncancerous Findings. In: Usatine RP, Smith MA, Chumley HS, Mayeaux EJ, Jr.. eds. The Color Atlas of Family Medicine, 2e. New York, NY: McGraw-Hill; 2013. Accessed December 14, 2015.

Clinical guideline titled "Screening for Cervical Cancer: U.S. Preventive Services Task Force
Recommendation Statement" by VA Moyer on behalf of the USPSTF published in the Annals of Internal Medicine in 2012.

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