Recommended frequency of Pap tests
The Pap test is the most effective screening test for cervical cancer. Testing should start within 3 years of a woman beginning sexual intercourse, whatever age that may be, but no later than 18 years of age. Check with your doctor about which screening schedule is recommended in your province or territory.
In general, you will have regular Pap tests based on your age and risk factors.1, 2
Women older than 30 may have different screening recommendations based on their risk factors.
- Women with a history of three normal Pap tests in a row may be screened every 2 to 3 years with conventional or liquid-based Pap tests.
- Women with a normal Pap test and a human papillomavirus (HPV) test that is negative for a high-risk HPV type should be screened every 3 years. More often than every 3 years is not necessary because these women are at very low risk for abnormal cervical cell changes.
- Women with the following risk factors may require more frequent screening.
- Exposure to diethylstilbestrol (DES) before birth (prenatal exposure). Between 1948 and 1971, millions of women took a drug called diethylstilbestrol (DES) to prevent miscarriage. Daughters born to women who took DES while pregnant have a slightly higher risk of developing abnormal cervical cells and cancer of the vagina.
- Infection with human immunodeficiency virus (HIV). Women infected with HIV should have screening twice in the first year after being diagnosed with HIV and yearly after that.
- A history of being treated for abnormal cervical cell changes or cervical cancer. Women with a history of moderate to severe cervical cell changes remain at risk for persistent or recurrent disease and should continue yearly screening.
- An impaired immune system, such as in those receiving chemotherapy. These women are at higher risk for having abnormal Pap tests and developing cervical cancer because the immune system is not able to fight abnormal cell changes. Any abnormal Pap test should be followed by colposcopy and appropriate treatment.
Women ages 65 to 70
Some provinces or territories recommend that women who have had three normal Pap test results in the past 10 years may decide to stop screening after ages 65 to 70. But other programs suggest women have regular Pap tests for life. You and your health professional can decide on the appropriate age to stop based on your medical history. Some risk factors that you will want to consider include:3
- Being sexually active with multiple partners.
- Having a history of abnormal cervical cell changes.
- Having a Pap test that is positive for HPV.
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 health professional can decide on the appropriate interval based on your medical history.
- Women without a cervix
- Pap testing does not need to continue if the cervix was removed for non-cancerous 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. Or testing should continue for life if it is recommended in your province or territory. 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.
After any abnormal Pap test, your health professional 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.
| Author: | Shannon Erstad, MBA/MPH Carrie Henley | Last Updated: April 10, 2007 |
| Medical Review: | Joy Melnikow, MD, MPH - Family Medicine Anne C. Poinier, MD - Internal Medicine Barbara S. Apgar, MD, MS - Family Medicine, Women's Health Ross Berkowitz, MD - Obstetrics and Gynecology Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology | |
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