How Often Should You Have a Pap Smear?

Cervical Cancer Screening Guidelines from the ACS and ACOG

A pap smear slide.
A pap smear slide. Environment Images/UIG/Getty Images

You likely have heard of the hype surrounding how often women need to undergo Pap smears. While healthy women used to undergo a Pap smear once a year, medical societies (for example, the American Cancer Society) now have spaced out the timing to every three years.

There are also set guidelines in place for when and at what age a woman should undergo HPV testing. The HPV test identifies women who are infected with high-risk strains of HPV that could lead to cervical cancer if left unmonitored or untreated.

With that, here is a summary of the recommendations from two medical societies: the American Cancer Society (ACS) and the American College of Obstetricians and Gynecologists (ACOG).

Cervical Cancer Screening Guidelines for Healthy Women

A woman should start screening for cervical cancer, which means undergoing her first Pap smear, at the age of 21, regardless of whether or not she is sexually active. Then, between the ages of 21 and 30, a woman should undergo a Pap smear every three years.

In other words, if your first pap smear is at age 21, your next would be at age 24, then at age 27, and then at age 30. During this period of time, HPV testing is not recommended. 

At age 30, a woman has the option of having an HPV test along with her Pap smear. 

If a woman chooses to have both a Pap smear and HPV test, she can wait five years between tests. If she chooses to only have a Pap smear, then it should be repeated every three years.

Of course, it's important to remember that this assumes a woman's pap smears are normal and that she is healthy. Women who have had previous abnormal Pap smears are infected with HPV, or are at high risk for cervical cancer may need to be screened more frequently.

For example, a 21-year-old woman with an abnormal Pap smear for the first time (for example, the pap smear results reveal LSIL) will need to have a repeat Pap smear in one year, as opposed to waiting three years.

In the end, it's important to follow the recommendations of your doctor, and if you are not clear, call your doctor's office to ensure you know the correct follow-up.

Cervical Cancer Screening Guidelines on Stopping Pap Smears

According to the American College of Obstetricians and Gynecologists, at age 65, women who have had three negatives ("normal") Pap smears in a row or two negative co-tests (meaning a "normal" Pap smear and negative HPV test) may discontinue having regular Pap smears.

This assumes that the most recent Pap smear was done within the last five years and that a woman has no history of moderate or severe abnormal cervical cells or a history of cervical cancer.

Cervical Cancer Screening Guidelines for High-Risk Women

Women at high risk for cervical cancer may need more frequent Pap smears based on their health status. This could be the result of weakened immunity, such as women with HIV. Women exposed to DES in utero may also need to undergo cervical cancer screening more often.

If your health care team advises more frequent testing, discuss the reasons for it with them so you understand why it is being done.

Cervical Cancer Screening Guidelines for Women Who Had a Hysterectomy

According to the American Cancer Society, women who have had a total hysterectomy, which means that the uterus and cervix were both removed, do not need to undergo any more screening.

However, this only applies to women who did not have a hysterectomy as a treatment for cervical pre-cancer or cancer. If this is the case, screening should still be continued, as cervical cells may still be present at the top of the vagina.

Women who have undergone a supra-cervical hysterectomy (meaning the uterus is removed, not the cervix) should follow the guidelines as usual. 

A Word From Verywell

The take home message here is that if you are healthy, you do not need to undergo a yearly Pap smear. But you still need periodic screening, like every three years or five years, depending on your age and whether you undergo an HPV test.

Regardless, though, seeing your gynecologist or family doctor once a year for a well-woman visit is important, even if you are not due for a Pap smear. During this visit, your doctor may perform a pelvic exam and a breast exam, as well as provide guidance for optimizing your overall health. 

Sources:

American Cancer Society. (2016). The American Cancer Society Guidelines for the Prevention and Early Detection of Cervical Cancer.

American College of Obstetricians and Gynecologists (ACOG). (2016). Cervical Cancer Screening. 

American College of Obstetricians and Gynecologists (ACOG). (2012). Well-Woman Visit. Committee Opinion.

Chiarelli AM, Maipruz V, Brown P, Thėriault M, Shumak R, Mai V. The contribution of clinical breast examination to the accuracy of breast screening. J Natl Cancer Inst. 2009 Sep 16;101(18):1236-43.

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. The Color Atlas of Family Medicine, 2eNew York, NY: McGraw-Hill; 2013

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