New USPSTF guidelines say annual Pap test not necessary for women 21 to 65

Women ages 21 to 65 should have a Pap smear every three years, according to new guidelines from the United States Preventive Services Task Force (USPSTF). Based on the evidence, women between the ages of 30 and 65 can safely extend the screening interval to once every five years if they undergo the humanpapillomavirus (HPV) test at the same time as the Pap.

The guideline is published online in Annals of Internal Medicine.

The USPSTF recommends against screening for cervical cancer in women younger than 21, as there is adequate evidence that screening in this population, regardless of sexual history, provides no reduction in cervical cancer incidence and mortality. Women older than 65 who have had adequate prior screening and are not otherwise at high risk also do not need screening, the guidelines say.

“This is good news for women because evidence shows that an annual Pap smear is not necessary to prevent deaths from cervical cancer,” said Task Force Chair Virginia Moyer, MD, MPH, professor of pediatrics at Baylor Medical College. “Screening every three years starting at age 21 saves the same number of lives as annual screening, but with half the number of colposcopies and fewer false-positive tests.”

USPSTF does not recommend HPV screening in women under the age of 30, as the infection is prevalent in younger women and often clears up on its own. 

According to the Center for Disease Control and Prevention, women aged 30 years old and older who have had a normal Pap result have a very low chance of getting cervical cancer in the next few years. This information supports the wisdom of extended screening intervals for cervical cancer. However, women should not skip regular check-ups, USPSTF says.

The guidelines also state that women who have had a hysterectomy with removal of the cervix and who do not have a history of cervical cancer or a high-grade precancerous lesion do not need to be screened. In this population, there is high certainty that harms of screening outweigh the benefits.

Women over the age of 65 can end screening if they have had three consecutive negative Pap smears or two consecutive negative co-tests within 10 years before cessation of screening, with the last test occurring within five years. Routine screening should continue at least 20 years after spontaneous regression or appropriate management of high-grade precancerous lesion, regardless of the patient’s age.

Physicians should consider cervical cancer screening in women over the age of 65 who have never been screened, USPSTF says.

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