- Women should get their first pap smear at age 21.
- From ages 21 through 65, women should get a pap smear once every three years.
- Pap smears can help identify
cervical cancer early on and save lives. - This article was medically reviewed by G. Thomas Ruiz, MD, OB/GYN Lead at MemorialCare Orange Coast Medical Center in Fountain Valley, CA.
A pap smear, sometimes called a pap test, is a procedure that screens for cervical cancer — and is typically done during an annual well-woman visit with a gynecologist.
In this article, we discuss how often you should get a pap smear and why they're so important in the first place.
Pap smears save thousands of lives each year
A pap smear only takes a few minutes during which time, a gynecologist will widen the vaginal opening with a device called a speculum. This gives the doctor room to reach the cervix, which is located roughly 4-7 inches deep and separates the vagina from the uterus.
Using a spatula-like instrument and a brush, the gynecologist will scrape a sample of cells from the cervix. These samples are then sent to a lab where they're tested for any abnormalities.
"Pap smears are designed for providers to detect any abnormalities prior to the development of cancer," says Tia Guster, MD, a board-certified gynecologist and obstetrician at Piedmont Physicians Obstetrics and Gynecology.
"Literally, pap smears save lives by finding abnormalities that can likely be resolved prior to developing into cancer," Guster says.
Since 1992, the number of cervical cancer cases and cervical cancer deaths has steadily declined, in part due to an uptick in screenings, like from pap smears, that detect cancer early enough for effective treatment.
In fact, cervical cancer death rates have plummeted by about 50% since the mid-1970s.
Get a pap smear every 3-5 years
"Screening guidelines are based on age," says Guster. Usually, a woman doesn't get her first pap smear until she turns 21 years old. That's in part because most women younger than 21 have a low cervical cancer risk.
According to the American Cancer Society, women from 35 to 44 years old making up the majority of diagnoses.
Starting in your 20s and lasting through your mid-60s, you should have a pap smear once every three years, according to both the CDC and The American College of Obstetricians and Gynecologists (ACOG).
For women 30 and older, your doctor might also recommend an HPV test. HPV, short for human papillomavirus, is a sexually transmitted infection. Your doctor may recommend screening for HPV because certain strains can lead to cervical cancer.
If you opt for the HPV test along with your pap smear — known as co-testing and is the preferred method, according to ACOG — you should have both tests once every five years.
Guster says that, for a woman of average risk, cervical cancer can take anywhere from 10 to 15 years to develop, so screenings every 3 to 5 years can help identify patients who might need additional monitoring before cancer has a chance to develop.
There are some exceptions to how often you should be tested, though. "Patients who have had abnormal pap smears in the past or a diagnosis of cervical cancer will need more frequent interventions and closer monitoring," says Guster.
When you have an abnormal pap smear test
If your pap smear test comes back with an abnormal result, then the gynecologist will usually perform a colposcopy. A colposcopy allows your doctor to get a more magnified look at your cervix and see if there are any problem areas.
"It seems like a longer version of a pap smear because the cervix is carefully reviewed for abnormalities," says Guster. During this procedure, if any abnormalities are detected, a portion of those cells will then be removed for biopsy.
Abnormal cells from a pap smear could be an indication of cervical cancer. However, it's important to note that just because you have an abnormal pap smear doesn't indicate that you automatically have, or will develop, cervical cancer.
In fact, cervical cancer is estimated to make up less than one percent of new cancer cases in 2020, according to the National Cancer Institute.
However, depending on the results of your colposcopy, the gynecologist may recommend more frequent pap smears or colposcopies.
Regular pap smears stop after age 65
Usually, when you reach 65, you won't need pap smears anymore as long as you haven't had cervical cancer or consecutive abnormal pap results for at least a decade.
"The great news is that women over 65 usually have a significantly decreased risk for cervical cancer," says Guster. That's because, in general, women in this age group "will have a long-standing history of normal pap smears as well less frequent lifestyle changes that would increase the risk for abnormal pap smears and cervical cancer."
If you have had cervical cancer or abnormal pap smears, your gynecologist may suggest continuing to get pap smears after age 65, though each care plan depends specifically on an individual patient's needs, says Guster.
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