How Often Do I Need a Pap Smear?

The reminder letter came three weeks ago. It’s in the pile with the rest of the mail you’re avoiding. You’re not sure if you’re due, or if the last one was two years ago or five, and you’d rather not think about the exam itself.

What the tests look for

The CDC¹ describes two tests. The HPV test looks for the virus that can cause cell changes on the cervix. The Pap test looks for precancers, cell changes that can become cervical cancer. The NCI² adds the cotest, which combines both. The NHS³ notes that screening used to be called a smear test.

How often

The CDC’s¹ schedule, for people with a cervix and normal results:

• Ages 21 to 29: a Pap test every 3 years.
• Ages 30 to 65: one of three options: an HPV test alone every 5 years, an HPV and Pap cotest every 5 years, or a Pap test only every 3 years.
• Over 65: you may be able to end screening if your earlier tests were normal.

The NCI² says the American Cancer Society recommends starting at age 25 with an HPV test, so guidelines differ. The NHS³ invites everyone with a cervix aged 25 to 64 for screening automatically, every 5 years in England. Ask your own clinician which schedule they follow for you.

After a hysterectomy, or at 65

The NCI² says if both the uterus and the cervix were removed, screening ends. If you’ve had a hysterectomy that left the cervix in place, you should continue routine screening. At 65 or older, it says to talk with your provider on whether screening is still needed, based on regular past screening with normal results.

An abnormal result

The CDC¹ says an abnormal result usually does not mean that you have cervical cancer. It says abnormal changes are likely caused by HPV, that minor changes often resolve on their own, and that more serious changes can turn into cancer if they’re not removed. That’s why follow-up matters.

The NCI² is open about the downsides: false-positive results that cause anxiety and unnecessary procedures, and false-negative results that can delay care.

Cost

The CDC¹ says free or low-cost screening is available through the National Breast and Cervical Cancer Early Detection Program. Check with your local health department if cost is what’s stopping you.

The play

Try this: a screening check

Find the date of your last Pap or HPV test, and the result. Check your patient portal, call your clinic or look for the last letter.

Ask: “Which test am I on, and when am I due next?”

Put the due date in your calendar now, along with the appointment. If you’re dreading it, say so when you book.

When to get checked

Book an appointment if any of these fit:

• You’re 21 or older and have never been screened
• You can’t remember your last screening, or it was more than 3 to 5 years ago
• You’ve had an abnormal result and haven’t had follow-up
• You had a hysterectomy and don’t know if your cervix was removed
• You’re over 65 and not sure if you can stop
• Cost is the barrier. Ask about the CDC¹-supported program.

Also see our articles on vulvar itching, spotting between periods and painful sex. Bleeding between periods or after sex, or pain, are reasons to see a clinician whether or not you’re due for a screening.

Screening exists to find changes early, while they’re still easy to deal with.