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Why it's done
By Mayo Clinic staffA Pap smear is used to screen for cervical cancer. The Pap smear is usually done in conjunction with a pelvic exam. In women over 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 around age 21 and then every two or three years. You may consider having a Pap smear less often after age 30 or if you've had multiple negative tests in a row.
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 or before age 21:
- The American Congress of Obstetricians and Gynecologists (ACOG) recommends having your first Pap smear at age 21.
- The American Cancer Society (ACS) recommends having your first Pap smear about three years after first having sexual intercourse or at age 21, whichever comes first.
- The U.S. Preventive Services Task Force (USPSTF) concludes it's not clear when to begin Pap smears, but points to evidence that recommends having your first Pap smear about three years after first having sexual intercourse or at age 21, whichever comes first.
Groups' guidelines differ for how often the tests should be done.
| Age | ACS | ACOG | USPSTF |
|---|---|---|---|
| 21 to 29 | Every two years with a liquid-based test or annually with a conventional test | Every two years | At least every three years |
| Over 30 | Every two or three years if you've had three negative tests in a row | Every three years if you've had three negative tests in a row | At least every three years |
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, 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 can stop having tests at 70 if she's had three negative tests in the last 10 years. USPSTF guidelines suggest stopping Pap testing at 65. ACOG guidelines say women can consider stopping Pap tests between ages 65 and 70 if they've had three consecutive negative tests and no abnormal tests in the last 10 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.
- The Pap test. American Congress of Obstetricians and Gynecologists. http://www.acog.org/publications/patient_education/bp085.cfm. March 17, 2010.
- Pap test. WomensHealth.gov. http://www.womenshealth.gov/faq/pap-test.cfm. Accessed March 17, 2010.
- Cervical cytology screening. American Congress of Obstetricians and Gynecologists. Obstetrics & Gynecology. 2009;114:1409.
- Smith RA, et al. Cancer screening in the United States, 2010: A review of current American Cancer Society guidelines and issues in cancer screening. CA: A Cancer Journal for Clinicians. 2010;60:99.
- Screening for cervical cancer. U.S. Preventive Services Task Force. http://www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.htm. Accessed March 17, 2010.
- Sirovich BE, et al. Screening for cervical cancer. http://www.uptodate.com. Accessed March 17, 2010.
- Cervical cancer screening. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/PDF/cervical_screening.pdf. Accessed March 17, 2010.
- Gallenberg MM (expert opinion). Mayo Clinic, Rochester, Minn. March 18, 2010.
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