A Pap smear, also called a Pap test, is a screening procedure that can detect cervical cancer. During a Pap smear, a doctor or practitioner collects cells from the cervix. The cervix is the opening to the uterus, and it is located at the top of the vagina. These cells are sent to a laboratory where they are examined for abnormal changes.
For many decades, Pap smears were conducted yearly during annual gynecological exams. Now, however, recommendations from health organizations have changed that timeline.
In 2012, the
Since that significant update in 2012, a few caveats have been added to the guidelines. Several organizations have differing opinions about the right time for a first Pap smear and for regular testing. Your doctor can discuss what’s best for you.
In this article, we will take a closer look at what current Pap smear guidelines are, how often people should be getting a Pap smear, and what to do if you think you’re not receiving the best testing strategy from your doctor.
Most of the Pap smear testing guidelines are established by age. Some other factors may influence how often you should have a Pap test.
|Under 21||No Pap test needed.|
|21||Begin Pap testing every 3 years.|
|21–29||A Pap test every 3 years is recommended.|
|30–65||Three options are available: A Pap test every 3 years, human papillomavirus (HPV) test every 5 years, or a co-test with both a Pap test and an HPV test every 5 years.|
|65 and older||Pap tests may not be necessary after age 65 if you’ve had several consecutive normal Pap tests in the decade before you reach 65.|
Do people under 21 need a Pap smear?
No, most people under 21 will not benefit from a Pap test.
Do people under 30 need an HPV test?
The short answer is it depends on the guidelines.
The most widely cited and utilized guidelines are from the U.S. Preventive Services Task Force. These say that people under 30 may not benefit from an HPV test. That’s because HPV, which is a sexually transmitted virus, is quite common. However, most people under 30 will clear the virus naturally. An early HPV test may be positive, but the virus is unlikely to cause precancerous cell changes.
On the other hand, the
If a Pap test detects precancerous changes to cervical cells, your doctor may request a follow-up HPV test, but in most cases, co-testing is done.
While the updated Pap smear guidelines aim to reduce the number of tests overall, some people may need tests more often.
You may be at increased risk of cancer and require more frequent tests if you:
- are HIV-positive
- have a weakened immune system, such as from chemotherapy or an organ transplant
- have HPV
If Pap results are abnormal, your doctor may increase the frequency of Pap smears, too.
A Pap smear is used to find signs of cervical cancer before symptoms appear. Specifically, the test aims to detect the presence of precancerous or cancerous cells.
To get a sample of your cervical cells, a doctor or practitioner will collect cells from the cervix using a small brush. This test can be uncomfortable, but it should not be painful.
Test results for a Pap smear fall into three categories:
- Normal Pap smear: No abnormal cells were detected. Most people receiving a normal, or a “negative,” result may be able to wait 3 years before repeating the Pap test.
- Abnormal Pap smear: This result does not mean you have cancer. It means that there were some abnormal cells detected in the test. If you receive an abnormal report, your doctor may want to do additional testing, such as an HPV test, or a colposcopy. This test allows the doctor to closely examine the cervix. They may also take a piece of tissue for testing. This is called a biopsy. You also may be asked to return in 1 year for screening.
- Inconclusive Pap smear: This result means your sample was poor, or the lab was unable to see enough cells to make a determination. You will likely need another Pap test.
The future of cervical screenings
The field of cervical cancer screening is generally moving away from Pap tests to HPV testing only. Experts are doing this in large part because it’s now known that the vast majority of cervical cancers are caused by high-risk strains of HPV.
If HPV is detected, then doctors aren’t waiting for those precancerous and cancerous changes to show up in the cells. Those changes may not always be obvious, and they may show up later than the initial infection.
In addition, HPV testing has been shown to be much better at picking up cervical disease than Pap testing. Adding Pap tests to HPV tests adds cost for only a small benefit in detecting disease.
Recommendations exist to help doctors guide patients through the best testing timeline. However, they are only recommendations. You and your doctor can decide what is best for you.
If you think you should be tested more regularly, ask your doctor. You can request additional testing. In certain cases, it makes sense to go outside the guidelines. However, it is important to note that more testing does not always mean better care.
Certain risk factors may increase how often your doctor recommends testing. If you have a change in medical history that increases your risk, tell your doctor.
While cervix changes caused by HPV are slow to develop, yearly testing may be useful for certain individuals. Talk with your doctor if you have concerns about your risk factors or other concerns about your reproductive health.
Over the past few decades, recommendations for Pap testing have changed. They are likely to continue to change as scientists and researchers make advances in detecting early-stage cancer.
Currently, the recommendations are individualized for people’s age and personal risk factors. Most people can have a Pap smear every 3 years. That timing may expand a bit after age 30, and HPV tests may be used in place of or in conjunction with Pap tests.
Regular Pap smears remain an essential screening tool. While the test may be uncomfortable, it is vital to have timely tests so that any changes can be detected early, and treatment can begin. Talk with a healthcare professional about the best recommendations for you.