Q: Who should get Pap tests? At what point do they become unnecessary? – Debra in Washington
A: Everyone with a cervix aged 21 to 65 years should be screened for cervical cancer every 3-5 years.
Screening should use either a Pap test that looks for pre-cancer or cancer cells on the cervix and/or a human papillomavirus (HPV) test that looks for the HPV virus.
Screening is recommended regardless of HPV vaccination status. Talk with your clinician to decide which test and which interval is most appropriate given your location and individual context.
The good news? Due to screening initiatives and increased rates of HPV vaccinations, cervical cancer is a cancer we can prevent altogether or treat early to prevent unnecessary suffering. 
In fact, HPV vaccinations are reducing new infections and cancers as we write. Since 2006, infections with HPV types that cause most HPV-related cancers and genital warts have dropped 88 percent among teens! 
Rates of cervical cancer and death among Hispanic and Black people with cervices are higher than the general population, so vaccination and screening initiatives in our communities of color are important public health priorities.
HPV is the most common sexually transmitted infection in the United States. By age 50, at least 4 out of every 5 people with cervices will have been infected with HPV at one point in their lives. For the majority of individuals, the infection will clear naturally within 2 years. About 10% of people with HPV infection on their cervix will develop long-lasting HPV infections that may put them at risk for cervical cancer.
The HPV vaccine is now available to people of all genders and sexes ages 9-26. Some adults ages 27 through 45 years who were not already vaccinated might choose to get HPV vaccine after speaking with their clinician about their risk for new HPV infections and possible benefits of vaccination for them.
To recap: vaccinate AND screen to prevent or catch cervical cancer early!
For ages 9-45, talk to your clinician about HPV vaccination.
For ages 21-65, talk to your clinician about getting screened using either the Pap test and/or the hrHPV test every 3-5 years. (Another new screening option you may hear about, especially if you live outside of the US, is the option for self-testing using the hrHPV test, either in the home or in the clinic. This method is being used in several countries across the globe and has been studied in the US. Self-collection or self-testing may be a readily available option in the future. The hope is that it will decrease some of the barriers to cervical cancer screening.)
**Certain risk factors further increase one’s risk for cervical cancer, including HIV infection, a compromised immune system, exposure to diethylstilbestrol as a fetus, and previous treatment of a precancerous lesion or cervical cancer. If you have one of these risk factors or any other concerns, you should participate in an individualized discussion with your clinician.
**If you have had a surgery called a hysterectomy to remove your uterus, ask your clinician if you need to keep getting screened. After a hysterectomy, you probably do not need screening if your cervix was removed along with your uterus AND you did not have cervical cancer or precancer.
If you’re not sure, your clinician can help you figure out if you need to continue screening.
It is also important to note that people without cervices may be at risk for cancers related to high-risk HPV. HPV-related cancers can also be found in the mouth, throat and anal regions. Talk to your clinician about any concerns you have about these areas of the body.
Note: These are the *current* guidelines in the US as described by the United States Preventive Services Task Force (USPSTF). The USPSTF is now reviewing the newest research and recommendations. They will have an update soon. Stay tuned.
Love,
Those Nerdy Girls
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Additional Links
Patient Education:
CDC – Human Papillomavirus (HPV) Facts & Brochures
CDC – What Should I Know About Screening?
References:
U.S. Preventive Services Task Force – Cervical Cancer: Screening
CDC- Cervical Cancer Statistics and Disparities
CDC – HPV Vaccine; rates of infection have dropped since 2006
UpToDate – Screening for cervical cancer in resource-rich settings
NIH – Methodologies of Primary HPV Testing Currently Applied for Cervical Cancer Screening
