Who should have a Pap test?

Patricia Geraghty, NP
Women's Health

Women should begin having pap tests at age 21. If the pap tests are normal, she should repeat the test every 3 years. At age 30, she may also test for HPV (human papilloma virus) with the pap test.

A woman who has had normal pap and negative HPV tests should continue to have pap tests every 5 years. She may stop having a pap test at age 65.

If a woman has had abnormal pap tests or is HPV positive, or has high risk conditions such as diethylstilbestrol (DES) exposure or is HIV positive, she will need pap tests or other testing as determined in discussion with her health care provider.

The woman who had a hysterectomy for reasons other than cancer, no longer needs to have pap tests.This is the consortium agreement from the expert panels at the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, the American Society for Clinical Pathology and the United States Preventative Services Task Force released in 2012.

The guidelines about how often pap tests should be done have been changing rapidly in the last decade. This is because of the explosion of information about the virus HPV that is largely, if not exclusively, responsible for changes in the cells of the cervix, or abnormal pap tests.

Finally, the pap test is about the health of the cervix only. The frequency of pap tests doesn't change a woman's need to take care of herself by having regular gynecological and breast examinations or discussions with her health care provider about her healthy lifestyle.

The most effective method for early detection of cervical cancer or abnormal cells that can lead to cervical cancer is having a Pap smear or Pap test. A Pap smear is a procedure in which cells are swabbed from the cervix and looked at under a microscope. Screening to check for abnormal cervical changes is a very important step in preventing most cervical cancers.

When and how often you should get a Pap test will depend on your medical needs and history. There are several guidelines that may help you and your healthcare provider decide what is best for you. The following summarizes the recommendations of the American Congress of Obstetricians and Gynecologists (ACOG):

  • The first Pap test should be at age 21.
  • Women 21-30 years old should be screened every two years.
  • Women over 30 who have had three consecutive negative Pap test results may be screened once every three years (more often if there are other related risk factors or health concerns).
  • Women who have had their uterus removed but not the cervix should still get a Pap test.
  • Women who have had both the uterus and cervix removed may stop getting Pap tests, unless the reason for the surgery was cancer. These women need to continue with the Pap tests to ensure all abnormal cells were removed.

Women can stop getting a Pap test after age 65-70 if the results of all Pap tests in the last 10 years were normal. All women still need a pelvic exam (a physical examination of the vagina, cervix, uterus, Fallopian tubes, ovaries and rectum) even if they no longer need a Pap test.

Dr. Kevin W. Windom, MD
OBGYN (Obstetrician & Gynecologist)

The Pap test recommendations have recently changed so don't be surprised if your doctor tells you something different. All women need their first test at age 21 and at least every other year until age 30. From 30-65 women need Pap tests at least every 3 years. You can quit at 65 years old if you have no risk factors and at least a decade of normal Pap tests.

I am a little different with my patients. I do the first pap at age 21 or 3 years after their first sexual encounter. At age 30 I start testing for HPV and if a patient has three normal Paps in a row and has low risk for cervical cancer then it is ok to have them every 2-3 years. Just remember that you need to see your healthcare provider every year regardless of having a Pap or not having one.

The American Cancer Society (ACS), the American College of Obstetricians and Gynecologists (ACOG) and the U.S. Preventive Services Task Force (USPSTF) recommend:

  • All women should begin screening at age 21.
  • Women ages 21 to 29 should have a Pap test every three years. They should not have a human papillomavirus (HPV) test unless it is needed because of an abnormal Pap test result.
  • Women ages 30 to 65 should have both a Pap test and an HPV test every five years or a Pap test alone every three years. (The ACS and ACOG prefer the two tests together every five years but say either method is acceptable; the USPSTF recommends either schedule.)
  • Women over age 65 who have been screened previously with normal results and are not at high risk for cervical cancer should stop getting screened. Women with cervical precancer should continue to be screened.
  • Women who have had a total hysterectomy, with removal of their uterus and cervix, and have no history of cervical cancer or precancer should not be screened.
  • Women who have received the HPV vaccine should still follow the screening guidelines for their age group.
  • Women who are at high risk for cervical cancer may need more frequent screening. Talk to your healthcare professional about what's right for you.

The Pap test is recommended for all women between the ages of 21 and 65 years old, and can be done in a doctor's office or clinic. Women should start getting regular Pap tests at age 21. In addition to the Pap test, the human papillomavirus (HPV) test may be used to screen for cervical cancer in women aged 30 years and older.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.