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Cervical Cancer Screening Guidelines for the Pap Test

The American Congress of Obstetricians and Gynecologists (ACOG) recommended Cervical Cancer Screening Guidelines for the Pap Test

In 2012, Alan G. Waxman, MD, of the University of New Mexico in Albuquerque stated that "the tradition of doing a Pap test every year has not been supported by recent scientific evidence." He supported that a review of evidence demonstrated that screening at less frequent intervals for cervical cancer is just as effective, has decreased costs, and avoids unnecessary and sometimes harmful interventions.

Cervical cancer is a slow growing cancer caused by certain strains of the human papillomavirus (HPV), an extremely common sexually transmitted disease among women and men. Many of those who have died from cervical cancer in the US were screened infrequently or not at all. Therefore, new screening recommendations were made for cervical cancer prevention by the American College of Obstetricians and Gynecogists (ACOG) in 2012.

AGOG Screening Guidelines:

  • Women should have their first cervical cancer screening at age 21 - Women under 21 should not be screened.Although the rate of HPV infection is high among sexually active adolescents, invasive cervical cancer is very rare in women under age 21. The immune system clears the HPV infection within one to two years among most adolescent women. Because the adolescent cervix is immature, there is a higher incidence of HPV-related precancerous lesions (called dysplasia). However, the vast majority of cervical dysplasias in adolescents resolve on their own without treatment.
  • Women between ages 21 and 29 should have a Pap test every 3 years. HPV testing should not be used in this age group unless it is needed after an abnormal Pap test result.
  • Women between the ages of 30 and 65 should have a Pap test plus an HPV test (called "co-testing") every 5 years. This is the preferred approach, but it is also OK to have a Pap test alone every 3 years.
    • Studies have shown that the chances of having significant new precancerous changes on a Pap Test after 3 years is 2-3/10,000 women or 8 actual cases of cancer among 100,000 women.
    • Women with certain risk factors (HIV, immunosuppressed, DES exposure in utero, history of cervical intraepithelial neoplasia (CIN) or cervical cancer) may need more frequent screening.
  • Women over age 65 who have had regular cervical cancer testing with normal results should not be tested for cervical cancer. Once testing is stopped, it should not be started again. Women with a history of a serious cervical pre-cancer should continue to be tested for at least 20 years after that diagnosis, even if testing continues past age 65.
  • A woman who has had her uterus removed (and also her cervix) for reasons not related to cervical cancer and who has no history of cervical cancer or serious pre-cancer should not be tested.
  • A woman who has been vaccinated against HPV should still follow the screening recommendations for her age group.

Do I Still Need to See My Healthcare Provider for a Yearly GYN Exam?

It is important to realize that your yearly Gyn Exam includes more than just a Pap Test! In addition to a breast, thyroid and heart and lung exam, the pelvic exam includes looking at the vulva and vagina, as well as feeling the uterus and ovaries. The annual Gyn Exam is also every woman's preventive health screening where early education, screening and intervention can make a big difference! Your gynecologist considers everything from contraception, sexuality education, and routine screening for sexually transmitted infection to menopause, breast problems and osteoporosis screening and treatment. Even though cervical screenings may not be required annually, women still need to have a yearly gynecologic exam to review their individual preventive health issues and to rule out any problems with their reproductive organs.

These exams can uncover problems such as:

  • Endometriosis
  • Incontinence
  • Ovarian Cysts/Cancer
  • Uterine Fibroids
  • Sexually Transmitted Infections
  • Pelvic Pain/Vaginal Pain
  • Prolapse of the Uterus, Bladder or Rectum
  • Sexual Dysfunction
  • Precancerous Changes of the Cervix
  • Pelvic Inflammatory Disease (PID)

Be sure to discuss these recommendations with your healthcare provider.

Information provided by:

Ob/Gyn Department, Chester County Hospital

Last Updated: 1/13/2015