Cervical cancer screening: when to start, how often, when to stop

When to start and how often

Sources: USPSTF (USPSTF 2018), American Cancer Society (ACS 2025) (ACS).

Under the American Cancer Society guideline, a self-collected HPV test every 3 years, a cotest every 5 years, or a Pap test every 3 years are acceptable alternatives to the preferred HPV test every 5 years (ACS). The guideline applies whether or not you have had the HPV vaccine (ACS).

The tests, in plain words

A Pap test (cervical cytology) looks at cells from the cervix for changes. An HPV test looks for high-risk types of human papillomavirus, the virus behind most cervical cancers. Cotesting means doing both on the same sample (USPSTF 2018).

Self-collected HPV tests

In December 2025 the American Cancer Society added HPV tests on a vaginal sample you collect yourself as an acceptable option. A sample taken by a clinician from the cervix is still preferred. If a self-collected test is negative, the guideline says to repeat it in 3 years rather than 5 (ACS 2025). The 2018 USPSTF recommendation mentions self-collection only as a way that might raise screening rates in future (USPSTF 2018).

The USPSTF is updating its recommendation. A draft posted in December 2024, which is a draft and not final, proposes a Pap test every 3 years from 21 to 29 and, from 30 to 65, an HPV test every 5 years as the preferred option, collected by a clinician or by the patient, with a Pap test every 3 years or a cotest every 5 years as alternatives (USPSTF draft 2024). Until it is final, the 2018 recommendation stands (USPSTF 2018).

When you can stop

Both groups say screening can stop after 65 only if earlier screening was adequate and you are not at higher risk (USPSTF 2018) (ACS 2025). In its 2025 update the American Cancer Society spells this out as negative HPV tests or negative cotests at ages 60 and 65, or three negative Pap tests in a row at the recommended interval with the last one at 65 (ACS 2025). If you have not been screened regularly, screening past 65 may still make sense. Your doctor can check your records.

Who is not at average risk

The USPSTF recommendation does not apply to people diagnosed with a high-grade precancerous cervical lesion or cervical cancer, people exposed to diethylstilbestrol (DES) before birth, or people with a weakened immune system, such as those living with HIV (USPSTF 2018). They need a schedule set with their doctor.

After a hysterectomy that removed the cervix, people with no history of a high-grade precancer or cervical cancer do not need screening (USPSTF 2018). The American Cancer Society says the same, unless the surgery was done for cancer or a precancer (ACS).

Why screening matters

The American Cancer Society expects about 13,360 new cervical cancer cases and 4,320 deaths in the US this year (ACS 2025). The USPSTF notes that most cases and deaths happen in people who were not adequately screened, followed up or treated (USPSTF 2018).

Common questions

At what age should you get your first Pap smear?

At 21 under the USPSTF recommendation (USPSTF 2018). The American Cancer Society starts at 25, with an HPV test instead of a Pap test (ACS).

Do I still need a Pap test if I am not sexually active?

The USPSTF recommendation applies to everyone with a cervix, regardless of sexual history (USPSTF 2018). If this applies to you, it is worth talking through with your doctor.

Do I need screening if I had the HPV vaccine?

Yes. The vaccine greatly lowers the risk but does not remove it, so the American Cancer Society guideline still applies (ACS).

My last result was abnormal. Does this schedule apply?

No. After an abnormal result, follow-up tests follow a separate schedule your doctor will set. This page covers routine screening only.

Also see the breast cancer screening check and the colon cancer screening check.