Screening Recommendations and Considerations

Cytological specimen showing cervical cancer

Cytological specimen showing cervical cancer, specifically squamous cell carcinoma in the cervix. Tissue is stained with pap stain and magnified x200. Source: NCI Visuals Online.

There are two cervical cancer screening tests—

  • The cervical cytology (Pap test) looks for precancerous and cancerous cells.
  • The HPV test looks for the DNA or RNA of the high-risk HPV types (16, 18, and others) that can cause these cellular changes.

Current Cervical Cancer Screening Recommendations

The U.S. Preventive Services Task Force (USPSTF) released an update of cervical cancer screening recommendationsexternal icon in August 2018.

Screening Methods for Average-Risk Asymptomatic Women

  • Age 21 to 29: Every 3 years with cytology (Pap testing).
  • Age 30 to 65: Every 5 years with HPV test alone (primary HPV testing), OR every 3 years with cytology, OR every 5 years with HPV co-test (Pap + HPV test). Note that the U.S. Preventive Services Task Force states that primary HPV testing or Pap testing alone are preferred options compared with co-testing.

When NOT to Screen

  • Younger Than Age 21: Screening is not recommended for women younger than age 21.
  • Older Than Age 65: No screening past age 65 if adequate prior screening can be assessed accurately (three consecutive negative cytology results within 10 years or two consecutive negative HPV results within 5 years before screening cessation, with the most recent test occurring within 5 years) and not otherwise at high risk for cervical cancer.
  • No Cervix: No screening if the cervix was removed for a benign reason.

Because screening is for women who don’t have symptoms or a recent history of abnormal results, these screening recommendations do not apply to women—

  • With a prior diagnosis of a high-grade precancerous cervical lesion or cervical cancer,
  • With in utero exposure to diethylstilbestrol, or
  • Who are immunocompromised (such as those who are HIV positive, organ transplant recipients, or on chronic immunosuppressants).

These women are considered at increased risk for cervical cancer and may need to be screened more often; they should receive individualized follow-up based on their specific conditions.

For more details on each screening method, including performance characteristics, benefits, and harms, visit Cervical Cancer Screening–For Health Professionals.external icon

Knowledge Check

Answer the question on your own and check your answer.

Answer: Educate her on screening recommendations, letting her know that Pap tests are not recommended for women under age 21, given that abnormal test results are likely to be transient and resolve on their own and resulting treatment may have adverse effects (for example, on future child-bearing). Offer HPV vaccination if she hasn’t received it yet or completed the series.

Page last reviewed: January 28, 2019