Topic Overview

A Pap test, or Pap smear, is the most effective screening test for cervical cancer. It's often part of a pelvic exam. Regular testing can help your doctor find and treat abnormal cell changes on your cervix before they develop into cancer.

When to start Pap tests

Experts differ on when is the best time to start having Pap tests. Some experts recommend that women should start within 3 years of becoming sexually active. Others say women should wait until they are 21. Talk with your doctor about when to start having Pap tests. If you are sexually active and wait to have a Pap test, it's still a good idea to have tests for sexually transmitted diseases.

How often to have Pap tests

• Women younger than 30 should have Pap tests every 1 to 2 years, depending on what they and their doctors decide.
• Women 30 and older who have had three normal Pap tests in a row may only need a Pap test every 3 years. Women can also have an HPV (human papillomavirus) test with their Pap tests. If the Pap and HPV tests are negative, women can have their Pap tests every 3 years. But women who are at a higher risk for cervical cell changes or cervical cancer may still need the tests more often, even if the results are normal.
• Women 65 and older who have had three normal Pap tests in a row and no abnormal Pap tests in the past 10 years may decide to stop having this test. When to stop having Pap tests is a personal choice and may depend on your past health, overall health, and your risk for cervical cell changes or cervical cancer. Talk with your doctor about whether you should stop or continue to have Pap tests. He or she can help you decide.

It's a good idea to talk with your doctor about your risk for cervical cell changes or cervical cancer. Experts agree that some women may need to be tested more often if they:

• Were exposed to DES (diethylstilbestrol) before birth (prenatal exposure).
• Have HIV (human immunodeficiency virus).
• Have a history of abnormal cervical cell changes or cervical cancer.
• Have a weakened immune system. Certain conditions (such as cancer) and certain medicines (such as chemotherapy) can weaken a person's immune system.

Having the HPV vaccine does not change your need for Pap tests. Women who have had the HPV vaccine should follow the same Pap test schedule as women who have not had the HPV vaccine.

Women who have had a hysterectomy

A hysterectomy is a surgical procedure in which the entire uterus is removed, usually including the cervix. Occasionally the cervix may be left intact (supracervical hysterectomy). You and your doctor can decide on the appropriate screening interval based on your medical history.

• Women without a cervix
  • Pap testing does not need to continue if the cervix was removed for noncancerous reasons.
  • Regular Pap testing should continue if the cervix was removed for precancerous changes but may be stopped after 3 normal Pap tests if you do not have any other continuing risk factors for cell changes (dysplasia).
  • Regular Pap testing should continue if the cervix was removed for cervical cancer.
• Women with a cervix
  • Regular Pap testing should continue until age 65 to 70 if the uterus has been removed but the cervix is still present. If a woman is unsure whether she still has her cervix, her health professional should do a gynecologic examination to determine whether the cervix is still present.

Women who have gone through menopause have an increased risk of false-positive Pap test results. For this reason, postmenopausal women with previous normal Pap tests may be advised to have Pap tests less frequently than every year.¹

After any abnormal Pap test, your doctor will recommend follow-up to monitor the cell changes.

Cervical cells can be collected by several different methods during a Pap test. Some experts believe that the type of collection method can help determine how often screening should occur. Research on these collection methods continues.

For more information, see the topics Abnormal Pap Test, Cervical Cancer, and Pap Test.