Annual Pap Tests Are a Thing of the Past

New guidelines by The American College of Obstetricians and Gynecologists (ACOG; Washington, DC, USA) recommend that women should be normally screened for cervical cancer every three to five years at most.

According to the new guidelines, women under the age of 21, even if they have had sexual intercourse, should not be tested for cervical cancer or human papillomavirus (HPV). This is because invasive cervical cancer is unusual in females younger than 21, even though HPV is common among sexually active teens. Most cervical abnormalities that are associated with HPV infection typically clear up on their own, making no treatment necessary. The College recommends that women ages 21 to 29 should no longer be tested for cervical cancer every two years, but once every three years.


Women aged 30 to 65 will see the biggest change in their screening guidelines. If they have negative results, they will be co-tested with the Pap test (the traditional or liquid-based method) along with HPV test once every five years. If HPV screening is not accessible, a Pap test by itself is sufficient once every three years.

Women older than 65 should no longer receive screening for cervical cancer if they have no history of cervical cancer; no history of cervical intraepithelial neoplasia (CIN) 2 or CIN 3; no history of adenocarcinoma in situ; if they have had three consecutive negative Pap test results, or two consecutive negative co-test results within the past 10 years, with the most recent test within the previous five years. Women, no matter what age, should discontinue routine screening if they have no history of CIN 2 or CIN 3, and who have had a hysterectomy with removal of the cervix (total hysterectomy).

Additionally, HPV-vaccinated women should follow the same guidelines as those who are unvaccinated. The recommendations are not meant for women who are immune-compromised, HIV-positive, or were exposed to diethylstilbestrol (DES) in utero. These females may need more to be tested more often. The new guidelines were published in the November 2012 issue of Obstetrics & Gynecology, and they are similar to the recommendations announced by the American Society for Colposcopy and Cervical Pathology (Frederick, MD, USA), the American Cancer Society, and other medical associations earlier in 2012.

“These recommendation changes are significant for physicians and patients alike. It will take some time and a lot of effort to re-educate everyone that the annual Pap is no longer the standard of care. It is critical, however, that women understand that their annual well-woman visit is still very important for many other aspects of their health care,” said David Chelmow, MD, who led the development of the ACOG guidelines.

Related Links:
The American College of Obstetricians and Gynecologists
American Society for Colposcopy and Cervical Pathology