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Pap Smear (cont.)

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When should women start and stop having Pap smears, and how often should Pap smears be performed?

The table summarizes the consensus of all the major organizations regarding these important questions. The key points of the table are as follows:

  • All the guidelines agree that Pap smears should be started within 3 years of first sexual activity or age 21, whichever comes first.
  • There are minor differences in the recommendations for the frequency and age at which to stop Pap smears.
  • Older women who have had many normal Pap smears in a row and have been regularly screened are highly unlikely to have an abnormal Pap smear. These findings point to stopping Pap smears in older women, as reflected by several of the guidelines in the Table.
  • Women who have had a total hysterectomy for a benign condition no longer have a cervix, and thus do not derive any benefit from screening for cervical cancer.
  • In contrast, women who have had a subtotal hysterectomy still have a cervix, and thus should be screened according to the recommendations of women who have not had a hysterectomy.
  • Women who have had a hysterectomy for abnormal Pap smears have their own special recommendations.

Special situations may impact the frequency of screening. For example, women who have had cervical cancer, exposure to diethylstilbestrol, or a compromised immune system (as with HIV infection, for example) should continue annual screening as long as they are in reasonably good health. Women who have had a hysterectomy for CIN2 or CIN3 (a type of abnormal Pap smear) should be screened until they have had three normal Pap smears, (and if no abnormal Paps show up in 10 years, they can stop having Pap tests).

Medically Reviewed by a Doctor on 2/21/2014

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