Most people need a Pap smear every three years, though depending on your age and the type of test you get, you may be able to go up to five years between screenings. The exact schedule depends on which screening method you and your provider choose, whether you’ve had abnormal results before, and a few other health factors. Regular cervical cancer screening has reduced cervical cancer incidence and death rates by about 70% in countries where it’s widely used, so staying on schedule matters.
Ages 21 to 29: Every 3 Years
Screening should start at age 21. From 21 to 29, the recommended approach is a Pap smear (cervical cytology) every three years. HPV testing alone isn’t the standard option for most of this age group because HPV infections are extremely common in younger people and almost always clear on their own. Testing for HPV too early tends to flag infections that would never cause problems, leading to unnecessary follow-up procedures.
There is one exception worth noting. The American College of Obstetricians and Gynecologists (ACOG) says that primary HPV testing every five years can be considered for average-risk individuals aged 25 to 29, based on the test’s proven accuracy in that age range. So if you’re in your late twenties, your provider may offer you this option.
The American Cancer Society takes a different position entirely. In 2020, ACS updated its guidelines to recommend starting screening at age 25 rather than 21, using an HPV test alone every five years. Their reasoning: the first generation of people vaccinated against HPV are now in their twenties, and vaccination has significantly reduced HPV infections and precancers in this group. Screening people aged 21 to 24 often catches infections that would resolve without treatment, and unnecessary procedures can have real side effects. Your provider may follow either set of guidelines, so it’s worth asking which approach they recommend for you.
Ages 30 to 65: Three Options
Once you turn 30, you have three accepted screening strategies. All are considered equally effective for average-risk individuals:
- Pap smear alone every 3 years
- HPV test alone every 5 years
- Co-testing (Pap smear plus HPV test together) every 5 years
The five-year intervals aren’t a sign of less thorough screening. HPV testing is highly sensitive at detecting the virus strains responsible for most cervical cancers, so when results come back negative, the risk of developing cervical cancer within the next five years is very low. That’s why adding HPV testing to the mix allows for longer intervals between appointments.
If you’ve been getting Pap smears every year out of habit, you’re not alone. Annual Pap smears used to be the standard recommendation. But guidelines shifted years ago based on strong evidence that screening every three to five years catches precancerous changes just as effectively, while reducing false positives and unnecessary biopsies.
When You Can Stop Screening
Most people can stop cervical cancer screening after age 65, provided they have a history of adequate negative results and no prior diagnosis of serious precancerous changes or cervical cancer. “Adequate” generally means a consistent track record of normal results over the prior screening period. If you’ve been screened regularly and everything has come back normal, your provider will likely tell you that you’re done.
If you’ve had a total hysterectomy (where the cervix was removed) for a non-cancerous condition and have no history of cervical precancer or cancer, you no longer need Pap smears or HPV tests. However, if the hysterectomy was performed because of precancerous cells or cervical cancer, ongoing surveillance is recommended for at least 25 years after treatment.
After an Abnormal Result
An abnormal Pap smear doesn’t mean you have cancer. Most abnormal results reflect minor changes caused by an HPV infection that your immune system will likely clear. But it does change your screening timeline.
For minor abnormalities, such as slightly irregular cells found alongside a documented negative HPV test, the typical recommendation is repeat HPV testing or co-testing in one year. If your provider uses Pap smears alone for follow-up rather than HPV-based testing, you may be asked to come back every six months instead. The goal is closer monitoring until it’s clear the abnormality has resolved or needs further evaluation.
More significant abnormalities may lead to a colposcopy, a procedure where your provider examines the cervix more closely and may take a small tissue sample. After treatment for precancerous changes, you’ll need more frequent surveillance testing, often for many years. Your provider will set a specific follow-up schedule based on what was found.
If You Have HIV or a Weakened Immune System
People with HIV follow a more intensive screening schedule because a compromised immune system is less able to fight off HPV infections, raising the risk that an infection will progress to precancer or cancer.
For people with HIV, screening starts at the time of diagnosis (as early as age 21) with annual Pap smears. After three consecutive normal annual results, the interval can be extended to every three years. From age 25 on, co-testing (Pap plus HPV) is also an option, again starting annually and moving to every three years after three consecutive normal results.
One critical difference: people with HIV should continue cervical cancer screening throughout their lifetime, rather than stopping at 65 as recommended for the general population. Similar extended screening schedules may apply to people who are immunocompromised for other reasons, such as organ transplant recipients or those on long-term immunosuppressive medications.
Self-Collection HPV Testing
In 2024, the FDA expanded approval for two HPV tests to allow self-collected vaginal samples. With these tests, you swab yourself rather than having a provider perform a pelvic exam. The catch: self-collection currently has to happen in a health care setting like a primary care office, pharmacy, or mobile clinic. It’s not yet approved for at-home use, though clinical trials are underway to collect the data needed for that approval.
Self-collection is designed to reduce barriers for people who avoid screening because of discomfort, anxiety, or difficulty accessing a gynecologist. It doesn’t change the recommended screening intervals. If self-collection becomes available at your provider’s office, the same three-to-five-year schedule applies based on your age and test type.