ACOG Pap Smear Guidelines

A Pap smear is a routine laboratory diagnostic test used by gynecologists to detect cell changes in a woman's cervix that might indicate a precancerous or cancerous condition. Until 2003, when the American College of Obstetricians and Gynecologists (ACOG) revised its original guidelines for cervical cancer screening, it was recommended that women receive a Pap test yearly, during their annual pelvic exams, from age 18 on. The guidelines were changed to eliminate unnecessary testing of younger and older women with no history of abnormal Pap smears and low risk of developing cervical cancer.

Under Age 21

The ACOG doesn't recommend pelvic examinations for girls under age 21 unless they have been sexually active or have a medical complaint such as pelvic pain, vaginitis or irregular menstrual periods. If a younger girl is sexually active, ACOG recommends a pelvic exam and Pap smear--along with routine testing for sexually transmitted diseases (STDs)--within three years following first intercourse. STD testing includes screening for chlamydia and gonorrhea, two common bacterial infections that are sexually transmitted. ACOG guidelines also recommend that all women between ages 19 and 64 who are sexually active be tested for human immunodeficiency virus (HIV).

Age 21 to 30

ACOG guidelines recommend that pelvic examinations with Pap smears begin at age 21 for women who have not been sexually active. Thereafter, annual screening should continue up to age 30. Women in this age group have a higher risk than older women of contracting human papillomavirus (HPV). HPV causes a precancerous condition in the cervix that can lead to cervical cancer. A gynecologist may recommend more frequent screenings for some women.

Over 30

From age 30 on, ACOG guidelines says that screening can be cut back to every two or three years whenever a woman has three consecutive test results that were normal; has no conditions that affect the immune system; was not exposed to the drug diethylstilbestrol (DES) while in utero (before birth); and has no other medical problems that require annual or semi-annual examinations. Routine physical pelvic exams should continue annually.

65 and Older

Although routine pelvic exams should continue after age 65, ACOG guidelines say that, under certain conditions, Pap smears can be discontinued at this point. If a woman has three consecutive Pap smears that are normal and had no abnormal results during the previous 10 years, has no history of cervical cancer, HIV or other conditions that affect the immune system, is not at risk of acquiring STDs and was not exposed to DES, Pap smears can be eliminated from the annual exam.

Exceptions

If a woman of any age has a complete hysterectomy for reasons other than cancer and has never had cervical cancer or abnormal Pap smears, Pap testing may be eliminated from routine pelvic exams, according to ACOG guidelines.