How Often Should You Have a Pap Smear?

Recommended Cervical Cancer Screening Guidelines

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

Many women are getting mixed messages about Pap smear guidelines. This is because screening Pap smears were previously recommended every year. The American Cancer Society (ACS) and the American College of Obstetricians and Gynecologists (ACOG) have reviewed the evidence and now recommend three-year intervals between routine screening Pap smears for women age 21 and older. That said, there are exceptions to this guideline that depend on your test results, age, and healthy history.

Routine Screening

The every-three-years rule applies to women who are considered healthy, who are not considered high risk for cervical cancer (see below), and who have no personal history of cervical cancer or pre-cancer. These women should start having regular Pap smears at the age of 21, regardless of whether or not they are sexually active.

An HPV test may be done at the same time as a Pap smear starting at age 30 in what's referred to as a co-test.

HPV Testing

Another method of cervical cancer screening, the HPV test identifies women who are infected with high-risk strains of human papillomavirus (HPV). This is the leading cause of cervical cancer if it is left unmonitored or untreated.

According to both ACS and ACOG, a Pap smear and HPV test should be done together every five years between ages 30 and 65 for healthy women without a known risk of cervical cancer., If a woman does not want an HPV test and chooses to only have a Pap smear, then the Pap smear should be done at three year intervals.

Your doctor may recommend an HPV test in advance of you turning 30 if your Pap smear shows early signs of pre-cancer changes.

Exceptions

If you are healthy and your Pap smears are normal, then you can follow the three-year or five-year schedule, depending on whether or not you are being co-tested for HPV. However, if you have had abnormal Pap smears, if you are infected with HPV, or if you are at high risk for cervical cancer, you may need to be screened more frequently.

While there are guidelines in place, your doctor will discuss your situation with you and make a judgment about your testing based on your overall health and test results.

For example, a 21-year-old woman whose first Pap smear is abnormal and shows low-grade squamous intraepithelial lesion (LSIL)—a very early, potentially pre-cancerous change in cervical cells—will need to have a repeat Pap smear in one year, instead of waiting three years.

Likewise, a 36-year-old woman with known HPV infection who has been treated for bone marrow cancer and has become severely immunosuppressed may need to have a Pap smear with HPV testing more often than every five years.

Gauging Your Risk of Cervical Cancer

You may be at a high risk of cervical cancer if you have any of the following risk factors:

  • Weakened immunity resulting from chemotherapy or immunosuppressive medications
  • Weakened immunity due to HIV infection
  • Exposure to diethylstilbestrol (DES) in utero; this synthetic hormone was prescribed to pregnancy women between 1940 and 1971 to help prevent miscarriage
  • A strong family history of breast cancer, cervical cancer, or ovarian cancer
  • A personal history of cervical cancer
  • Pre-cancerous changes on previous Pap smears
  • Infection with HPV, especially before the age of 21

After a Hysterectomy

Women who have undergone a supra-cervical hysterectomy, in which only the uterus is removed, not the cervix, should follow the standard Pap guidelines, unless otherwise directed by their doctors.

According to the ACS, 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 a hysterectomy was done to remove cervical cancer, screening should still be continued, because cervical cancer cells may invade the upper region of the vagina.

Stopping Pap Smears

According to the ACOG, at age 65, women who have had three normal Pap smears in a row or two negative co-tests 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.

A Word From Verywell

Pap smears and HPV tests are crucial, as cervical cancer often arises and advances without any symptoms. In addition to Pap smears and HPV tests, you should see your gynecologist or family doctor once a year, 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. 

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