Actually, Most Women Don’t Need an Annual Pap Smear

Illustration for article titled Actually, Most Women Don’t Need an Annual Pap Smear

Cervical cancer can be deadly and is treatable if caught early — which makes regular screenings really important. But according to clinical guidelines released yesterday by the American College of Physicians, many women are getting screened far too often.


Top image: Tom Schoumakers/

The ACP’s “best practices” recommendations join (and are largely identical to) the screening guidelines put forth by the US Preventative Task Force in 2012. The rules are very straightforward, and address when women should get either Pap tests (which examine cervical cells for abnormalities) or genetic tests that identify whether a woman is carrying a cancer-causing strain of the human papillomavirus (HPV).

1. If you’re under 21, you don’t need a Pap test. Period. Very young women often have abnormal cervical cells that are not precancerous and will eventually disappear on their own; these cells turn up as false positives on the test. You also don’t need an HPV test: women are most likely to contract HPV after they first become sexually active, but often successfully fight off the infection on their own. More widespread use of the HPV vaccine may eventually let women wait even longer before their first test.

2. If you’re between the ages of 21 and 30, get a Pap test every 3 years. It takes an average of 10 years for precancerous cervical cells to develop into full-blown cervical cancer. A test every 3 years has a good shot at catching the problem early. You still don’t need an HPV test.

3. After you turn 30, you can switch to screening once every 5 years if your doctor does both a Pap test and an HPV test and both come back negative. Cervical cancers are a result of a persistent infection of specific strains of HPV, so an HPV screen at this point identifies women whose bodies have not been able to fight off the infection. Or you can keep having Pap tests every three years as before. Your call.

4. Once you’re over 65, you can stop getting screened for cervical cancer altogether if you’ve had either three consecutive negative Pap tests or two consecutive negative Paps paired with negative HPV tests. Congratulations, you’re really unlikely to get cervical cancer.


5. If you’ve had your cervix removed as part of a hysterectomy, you don’t need to get a Pap smear ever again. No cervix, no cervical cancer.

All of these guidelines apply to women who’ve never been diagnosed with either a precancerous lesion or cervical cancer. Women who’ve had either of these conditions, who were exposed to DES in utero, or who are immunocompromised for any reason should be screened more often.


[Sources: Annals of Internal Medicine 2015 and 2012, Gibb and Martens 2011]



Yeah, but how do you get around it when your doctor requires you to come in for an annual exam to get your birth control prescription refilled?