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Why it's done
By Mayo Clinic staffA Pap smear is typically done in conjunction with a pelvic examination — a procedure that allows your doctor to examine your external genitals, vagina, uterus, ovaries and rectum. Although pelvic examinations can screen for reproductive problems or abnormalities, only a Pap smear will detect early cervical cancer or precancers.
Who should have a Pap smear?
A number of organizations have recommendations regarding when a woman should have a Pap smear. Organizations' guidelines differ slightly because each takes different factors into consideration.
In general, groups agree that you should have your first Pap smear at or before age 21. The American College of Obstetricians and Gynecologists (ACOG) recommends women have their first Pap smear at age 21. The American Cancer Society (ACS) and the U.S. Preventive Services Task Force (USPSTF) recommend a woman has her first Pap smear about three years after first having sexual relations or at age 21, whichever comes first.
After beginning Pap smears, groups' guidelines differ as to 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 | Pap tests 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 | Pap tests at least every three years |
If you have certain risk factors you may need to undergo a Pap smear more often, 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
Talk to your doctor about how often you should undergo Pap smears.
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 fibroids, you may be able to discontinue routine Pap smears. If your hysterectomy was for a precancerous or cancerous condition, you should have an annual vaginal Pap smear.
- Older age. Groups don't agree whether there's an upper age limit for 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.
