Cervical Cancer Screening Guidelines

Age-Based Screening Recommendations

The American College of Obstetricians and Gynecologists recommends that cervical cancer screening should begin at age 21 years regardless of sexual activity status, including women who have never been sexually active 1, 2
No screening is recommended for women under age 21, regardless of sexual activity history, due to the extremely low incidence of cervical cancer in this age group 1, 2, 3
The preferred approach for women ages 30-65 is Pap test plus HPV co-testing every 5 years, while an alternative approach is Pap test alone every 3 years 1, 2
Discontinue screening if adequate prior screening with normal results has been documented for women over age 65, regardless of current or past sexual activity status 1

Cervical cancer incidence is extremely low before age 21, even among sexually active women, making age-based screening more effective 3
Self-reported sexual activity history is often unreliable for determining screening needs, and HPV exposure can occur through non-penetrative sexual contact, making sexual history an imperfect screening criterion 2, 3

Women with HIV, immunocompromised status, or history of cervical cancer may require more frequent screening based on clinical judgment, but screening should still not begin before age 21 1
Women who have had their cervix removed and have no history of high-grade precancerous lesions or cervical cancer should discontinue screening 1

Explain that screening begins at age 21 for all women, regardless of sexual activity, and clarify the purpose and importance of Pap testing for cervical cancer prevention 2, 4
Discuss the recommended screening intervals to prevent unnecessary annual testing, and provide written documentation that a Pap test was or was not obtained during the visit 2, 5