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Types of Cancer > Gynecologic Cancers > Cervical Cancer > Screening

Pap Smear Recommendations

Christina Chu, MD
Affiliation: The Abramson Cancer Center of the University of Pennsylvania
Last Modified: January 7, 2004

Within the past 2 years, the American Cancer Society issued new recommendations for cervical cancer screening. These recommendations were reviewed and endorsed by the Society of Gynecologic Oncologists and the Gynecologic Cancer Foundation as well. The newer guidelines represent some important changes from the past recommendations, particularly in regards to how frequently a woman needs to be tested. Women should keep in mind that having a pelvic examination is not the same thing as having a Pap test to screen for cervical cancer. A pelvic examination where a physician evaluates the pelvic organs (such as the vulva, vagina, cervix, uterus and ovaries) is part of routine health care for women and is recommended on a yearly basis. Cervical cancer screening may be performed before a pelvic examination at the same office visit, but is not the same thing.

When should I start getting tested for cervical cancer?

Women are advised to begin Pap testing either three years after the onset of vaginal intercourse, or at the age of 21, whichever comes first. It is important to note that Pap testing is only one part of comprehensive gynecologic care. Any adolescent who is currently sexually active or contemplating sexual activity should seek gynecologic care and be provided appropriate preventative health care, contraception counseling, as well as screening and treatment for sexually transmitted disease.

How often do I need to be tested for cervical cancer?

After the initiation of cervical cancer screening, women should continue to undergo testing with either a conventional Pap smear every year, or a liquid-based Pap test (such as Thin Prep) every 2 years. At or after the age of 30, women who have had 3 consecutive normal tests may then have screening extended to once every 2 to 3 years. An important exception to this recommendation is for women who are at higher risk of cervical cancer-such as women exposed to DES in utero, or those who are HIV positive or immunocompromised for another reason.

Some laboratories may offer human papilloma virus (HPV) DNA testing that may be done at the same time as a Pap test. Currently, HPV testing is only indicated in cases when the Pap test shows "atypical cells of undetermined significance" or ASCUS. In this case, when additional testing shows the presence of high risk HPV, patients should undergo colposcopy for further evaluation. Patients with the diagnosis of ASCUS who test negative for high risk HPV may be followed with another Pap test in approximately 6 months.