How Often Do You Really Need a Pap Test? We Spell Out the New Guidelines
Most women know the Pap test as a necessary evil, or at least a necessary nuisance: The procedure, which takes only a few seconds but is often considered awkward and unpleasant nonetheless, is often performed at a woman’s annual “well visit” with her gynecologist or primary care physician. During the test, a doctor collects a sample of cells from the cervix, which are examined under a microscope to check for abnormal (and potentially cancerous) growths.
What many women are less familiar with, however, is exactly how often they really need a Pap test—especially in recent years as guidelines have changed and different tests have become available. Just today, the U.S. Preventive Services Task Force (or USPSTF, a panel of experts that reviews screening guidelines and suggests updates when new research warrants them) issued a new recommendation statement on screening for cervical cancer, including slight tweaks to the standard Pap test schedule.
The USPSTF’s new recommendations include both the Pap test and a separate test for the human papillomavirus (HPV), a sexually transmitted infection that can cause cervical cancer. Both tests are very effective, Task Force Vice Chair Doug Owens, MD, tells Health, and they can both prevent deaths by detecting cervical cancer early enough that it can be treated.
“Most deaths from cervical cancer appear in women who were not screened or were not treated appropriately, so it’s really crucial for women to get screened regularly,” says Dr. Owens. So what does “regularly” actually mean? Here are the new recommendations, broken down step-by-step.
If you're 21 to 29: Get a Pap test every three years
There’s not exactly anything new in this part of the USPSTF’s announcement; the same schedule has been recommended for this age group by the American College of Obstetricians and Gynecologists (ACOG) for several years.
While the newer HPV test has some advantages over the Pap test for women 30 and older, that’s not the case with younger women, says Dr. Owens. “Young, healthy people generally don’t need to be screened for HPV, because these infections usually clear up without causing any health problems,” he says. “If you were giving them all HPV tests, you’d be detecting things that are going to go away on their own,” he says.
Pap tests are a better option for this age group, he adds, since they only detect abnormal cells that have already started to grow and multiply. Only if a Pap test comes back abnormal (which happens in 2% to 5% of cases) will doctors order additional tests or recommend follow-up screenings more frequently.
RELATED: 17 Things You Should Know About HPV
If you're 30 to 65: Choose one of three options
For women 30 and over, the recommendations get a little more involved. According to the USPSTF, these women can either opt for a Pap test every three years, an HPV test every five years, or a combined HPV and Pap test every five years.
In other words, women can continue getting tested every three years as they had been previously. Or, if they’d rather space out their tests, they can opt for an HPV test instead of or in addition to their Pap.
Dr. Owens says this decision should be made by a woman in conjunction with her gynecologist or primary care physician. Some women may feel better getting a test every three years, while others may prefer less frequent screenings.
A previous draft of the USPSTF recommendation did not recommend co-testing. But the panel concluded that, depending on where a woman lives and what doctor she visits, she may not have access to the HPV test alone. For that reason, all three options were included in the final recommendation.
“The good news is, we feel that all three of these options are very effective,” says Dr. Owens. He also points out that, whether a patient chooses Pap tests, HPV tests, or co-testing, the in-office experience is no different: They all involve a similar procedure and will feel the same to the patient.
If you're outside of those age ranges: You probably don't need screening
Doctors used to recommend that women get their first Pap test three years after they became sexually active and no later than their 21st birthday. But in 2012, ACOG changed its guidelines and stated that women younger than 21 actually shouldn’t be screened.
Rates of cervical cancer have declined so much since the 1970s that the disease is now extremely rare, ACOG said at the time, especially in women under the age of 30. Moving up the lower age for screening could still pick up a majority of early cancers, while preventing “a lot of unnecessary pelvic exams and unnecessary potential treatments,” said Alan Waxman, MD, who helped prepare ACOG’s recommendations in 2012.
The same goes for women over 65: As long as they’ve kept up with their screenings in previous years and are not otherwise at high risk for cervical cancer, they no longer need either test. Neither do women, of any age, who have had their cervix removed via hysterectomy.
What if you've had the HPV vaccine?
If you’ve been vaccinated against HPV, you should still follow the recommendations for your age group, says Dr. Owens. “In the future, we hope to have more evidence on the impact of the HPV vaccine,” he says. “But as of now, this applies to women whether they were vaccinated or not.”
In 2016, a study in the Journal of the National Cancer Institute suggested that women who have had all three doses of the HPV vaccine may only need four cervical cancer screenings in their entire lifetime, and that one day, women may be able to self-administer HPV tests at home. The authors agreed, however, that it’s too early to change any of the current, standard recommendations.
Do fewer tests mean fewer doctor's visits?
Not necessarily: Just because you don’t get a Pap or HPV test every year, that doesn’t mean it’s okay to skip your annual check-up or well-woman visit. Your doctor may still want to perform other screenings, like pelvic and breast exams, and speak with you about your overall health and lifestyle. Many doctors require a yearly appointment in order to renew birth control prescriptions, as well.
Dr. Owens says the frequency of doctor’s visits isn’t part of the new cervical cancer screening recommendations, and that the Task Force isn’t commenting on how often women should see their physicians. But Jane Kim, PhD, professor of health decision science at the Harvard T.H. Chan School of Public Health and co-author of the 2016 study mentioned above, did address this issue when she spoke with Health that year.
“I think we would still want to preserve the opportunity for women, especially as they’re aging, to intersect with their ob-gyn,” she said. “This shouldn’t be conflated with your regular well-woman visit; we’re talking strictly about whether you need this screening or not.”
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What else do I need to know?
Now that the Task Force’s recommendations are finalized, it’s important for doctors and health care professionals to focus on making sure all women in these age ranges receive screening, Dr. Owens says. “We know there are some women who aren’t getting them—there are disparities. So we really need to redouble our effort to make sure that all women have this available to them.”
ACOG and the Society of Gynecologic Oncology also released a joint statement today thanking the USPSTF for including several options for women in their recommendations and reiterating the call for accessible and affordable screening.
"With a number of screening options now available, the new guidelines emphasize the importance of the patient-provider shared decision-making process to assist women in making an informed choice about which screening method is most suitable for them,” the statement read. “However, more importantly, there needs to be a continued effort to ensure all women are adequately screened because a significant number of women in the country are not. It's also essential for women to have access to all of the tests and that they are appropriately covered by insurance companies.”