Women aged 21 to 65 years should undergo cytology (Papanicolaou, or Pap, smear) for cervical cancer every 3 years, but those aged 30 to 65 years who want to lengthen the screening interval to every 5 years by undergoing cytology and human papillomavirus (HPV) testing, based on new evidence showing this to be an acceptable screening strategy.

These updated recommendations from the US Preventive Services Task Force (USPSTF) replace the committee’s 2003 guidelines for cervical cancer screening. Whereas the 2003 version suggested that screening begin within 3 years of onset of sexual activity or at age 21 years—whichever came first—and that screening be done at least every 3 years, the new recommendations advocate no screening for women younger than 21 years, regardless of sexual history, because adequate evidence shows that screening does not reduce cervical cancer incidence or mortality.

The new document does, however, reaffirm two previous recommendations against screening:

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  • The USPSTF continues to recommend against screening for women who are older than 65 years, have had adequate prior screening, and are not otherwise at high risk for cervical cancer.
  • Screening is still not recommended for women who have had a total hysterectomy with removal of the cervix and no history of a high-grade precancerous lesion (cervical intraepithelial neoplasia grade 2 or 3) or cervical cancer. The harms of screening outweigh the benefits for this group.

Women younger than 30 years should not undergo HPV screening, either alone or in combination with cytology, due to current evidence suggesting moderate harms of HPV testing for these women, according to the USPSTF. Although HPV is prevalent in women younger than 30 years, the infection often clears up on its own and the incidence of cervical cancer in this age group is too low to justify the potential harms caused by false-positive test results and unnecessary colposcopies and biopsies.