Depending on your age, you might equate annual wellness visits to the gynecologist with getting a Pap test (or Pap smear, as they used to be known). This is a common and effective test that is used to screen for cervical cancer and precancerous changes to the cervix. Also depending on your age, you may perceive that guidelines around Pap tests have changed multiple times–and you would be right!
Pap tests have become routine in the United States, lowering the rate of cervical cancer deaths by more than 50% in the last 30 years. As with most areas of science and medicine, research is ongoing and our understanding of cervical cancer has evolved. We now know a lot more about what causes it and how the disease progresses over time. This has led to new and better guidelines for Pap tests and the introduction of new tools to screen for HPV, the virus behind the vast majority of abnormal Pap results and cervical cancer. I’ll talk more about why our recommendations have changed below, but here are the current guidelines first:
- Age 21 to 29: Pap test alone every three years.
- Age 30 to 65: There are three options here: Pap test alone every three years, HPV testing alone every five years, or Pap test and an HPV test together every five years. (This is called “co-testing.”)
- Older than 65: Can stop cervical cancer screenings if you have never had abnormal cervical cells or cervical cancer, and you’ve had 10 years of negative screening results.
Why are Pap tests no longer done annually?
Human Papilloma Virus (HPV) is the cause of 95% of cervical abnormalities, abnormal Pap smears and cervical cancer. Most HPV infections–both the high-risk variety that can lead to precancerous changes and cancer and the low-risk variety that cause genital warts–are temporary and resolve on their own without any treatment. Only a small number of infections are persistent, and these can cause the changes that can eventually lead to cancer.
Furthermore, most HPV-related precancerous changes progress very slowly. Even severe precancerous changes take, on average, three to seven years to evolve into cancer. This new knowledge of HPV is one of the main reasons for changes in the recommended frequency cervical cancer screening throughout a person’s life.
More good news? Despite the prevalence of the virus, the HPV vaccine is safe and effective at preventing HPV infections when started early, before most young people become sexually active.
No cervical cancer screening before age 21.
Why are Pap tests not recommended before 21?
Screening before age 21 has been shown to be unnecessary and even potentially harmful. While teenagers and young adults have the highest percentage of HPV infection, cervical cancer in this group is extremely rare–fewer than 1 in 1,000 cases. Research has shown that cervical cancer screening does not reduce this already low rate and can lead to unnecessary treatment by detecting abnormalities that will go away on their own. These treatments carry a risk of injury and future pregnancy complications.
Age 21 to 29: Pap tests every three years.
Even though we can now test for the HPV virus, we don’t typically recommend it as part of routine screening during this time. While HPV infections are still common for this age range, our bodies continue to be pretty effective at clearing them on their own. Your clinician will likely recommend HPV testing if you have an abnormal Pap test (this is called “reflex” testing) to determine follow up recommendations.
Age 30 to 65: Screening every three to five years, depending on the screening test.
Routine screening options during this time include Pap tests alone every three years, HPV testing alone every five years, or a Pap test and an HPV test together every five years. The choice here is part personal preference, part medical history. Your gynecologist can help you weigh the pros and cons and pick what’s right for you.
Curious what your Pap test results mean? Be sure to ask your provider if you have any questions.
Over age 65: cervical cancer screening can be stopped in certain circumstances
At what age do you no longer need a Pap test?
If you don’t have a history of cervical cancer or precancerous changes and you’ve had 10 years of negative screening results, you can likely stop screening for cervical cancer.
Remember: you still need to have screening even if you’ve been vaccinated for HPV and certain people may opt for more frequent screening, depending on their health history–such as past screening results, HIV status, a weakened immune system or history of cervical cancer. Talk to your provider about your situation.
How often should I go to a gynecologist?
Even though you may no longer need cervical cancer screening every year, an annual wellness exam has other important benefits. Good preventative health care addresses a wide range of issues tailored to a person’s age, personal and family history and other risk factors. This can include breast exams and mammograms, vaccinations, screening for sexually transmitted infections, reviewing your method of contraception and discussing what you’re doing to optimize your health and protect against disease. It’s also an opportunity to raise issues related to your menstrual cycle, bladder health and sexual function–although diagnosing and developing a care plan for new symptoms will likely require a follow-up appointment.
Schedule your wellness visit online or contact an office.