Pap Smear Frequency: Less is More!

By Dr. Wesley Davis

Good news for those who dread the yearly pap: It is a thing of the past! I still recommend a yearly exam (or every two years at least), but paps are no longer every year.

Here’s the scoop: pre-cancerous changes of the cervix are caused by HPV (Human Papilloma Virus). Most severely abnormal paps come from HPV subtypes 16 and 18. The changes take years to occur, and can be seen easily on the newer liquid based paps. So, if your pap is normal this year, even if you have acquired HPV, there are many years to follow before anything goes really bad. That gives us plenty of time to catch it and treat it before cancer occurs. That is the logic for doing away with yearly paps. Also, there is now a viral test for HPV types 16 and 18–so if you test negative for that, then your pap is needed even less frequently.

So, the 2015 guidelines state:

  • First pap at 21
  • Then (if the pap was normal) have a pap every 3 years throughout your twenties, and only test for HPV in a specific scenario (a pap result called atypical squamous cells of undetermined significance). It is recommended to have a yearly screen for chlamydia (a sexually transmitted bacteria that can cause infertility if not treated) in your twenties at least while you are single.
  • Starting at 30: “co-test” with both the pap and the HPV test. If both are normal, repeat every 5 years.
  • Your last pap can be in your mid 60’s. (Yay!).
  • Also, you should have received Gardasil (the HPV vaccine against type 16 and 18) before age 26-this reduces the risk even further.