Here's How Often You Need a Pap Smear

Since the Pap smear was introduced in 1943 through a book coauthored by Dr. George Nicholas Papanicolaou, the rates of cervical cancer have plummeted. In the beginning of the 20th century, it’s estimated that 24-37 women out of 100,000 women were diagnosed with cervical cancer, but by 2008, the rate drops to only 7.5 out of 100,000.

Considering how fast, simple, and relatively pain-free the Pap test is, however, those rates should even be lower. Pap smears save lives. And they take almost no time at all. In addition, a Pap smear may be included as part of your well-woman exam and could be 100% covered by your insurance.

If every woman who should have a Pap smear did have a Pap smear, almost nobody would die from cervical cancer. Pap tests help your doctor detect the early changes of cervical cancer so it can be cured. Once cervical cancer progresses, however, it may not be curable.

At Elite Gynecology, our expert gynecologists, Molly McBride, MD, and Tamara Guichard, MD, recommend that all women who are sexually active (or ever were) have regular Pap smears. Cervical cancer grows very slowly, so a Pap smear can literally save your life.

When and how often should you get Pap smears? The answers are below. 

Have you been sexually active and are over 21?

If you’ve ever experienced sexual intimacy — whether with penetration or not — you’re at risk for cervical cancer. The main cause of cervical cancer is infection with the human papillomavirus (HPV). Although most sexually transmitted diseases (STDs) are passed through bodily fluids, you only need intimate touch to transmit HPV.

In most cases, you don’t need to start Pap smear testing until you’re age 21. However, if you had any kind of sexual abuse or exposure as a child, let us know, and we may start you earlier than age 21.

Are you between 21 and 29 years old?

If you’re between the ages of 21 and 29, the American College of Gynecology (ACOG) recommends that you have a Pap test every three years. If you’re between the ages of 25-29, you can opt for a test that detects the presence of an HPV infection. However, we recommend Pap smears, regardless. 

In addition, you may benefit from an HPV vaccine, which can prevent the transmission of HPV and therefore lower your risk for cervical cancer.

Are you between ages 30 and 65?

Once you hit age 30, your options increase. ACOG recommends that you choose from:

• Combined Pap smear and HPV test every five years
• Pap test alone every three years
• HPV test alone every five years

Again, although the ACOG guidelines allow you to choose an HPV test by itself, we feel more comfortable with either Pap tests alone or in combination with HPV testing. Pap smears have a long, successful record of detecting early cancerous changes in cervical cells. We know they improve your odds.

Are you 65 or older?

At age 65, you may be able to stop or slow down your Pap smears. You can stop screening altogether if you’re at least 65 years old, you have no history of cervical changes, and you have either:

• Three negative Pap tests in a row
• Two negative HPV tests in a row, or
• Two negative combined Pap and HPV tests in a row in the past 10 years

Depending on the type or types of test you’ve had, the most recent one should have been performed within the past 3-5 years.

Are you one of the exceptions?

The guidelines above are for the general population of women. However, in special situations, you may need a different guideline.

You may need more frequent screening if you have any of the following added risks:

• A weakened immune system
• Infection with human immunodeficiency virus (HIV)
• A history of cervical cancer
• Exposure to diethylstilbestrol before birth

If you had a hysterectomy with removal of your cervix, you need to continue screening for 20 years if you have a history of cervical cancer or moderate-to-severe cervical changes. However, if your cervix was removed and you don’t have a history of cervical cancer or cervical changes, you can stop Pap tests.

To set up your Pap smear or well-woman exam, contact our office nearest you — in Midtown East, Murray Hill, New York City, or Forest Hills, New York — or use our online appointment button.