New Guidelines

Experts: Pap Smears Should Start At 21

Is our society plagued by chronic over-screening? The American College of Obstetricians and Gynecologists, the leading professional organization for obstetricians and gynecologists, has changed its recommendations about pap smears. The ACOG now recommends that regardless of when sexual activity is begun, young women should wait until age 21 for their first Pap smears, and repeat the test every two years, not annually. At age 30, a woman should undergo the test every three years, provided she has no history of cervical cancer and three clean Paps in a row. Previously, the ACOG recommended that women begin annual Pap tests three years after having sex for the first time, or no later than age 21. The change in policy is due to a 50 percent decline in rates of cervical cancer since the 1970s. New HPV vaccines such as Gardasil are likely to reduce the rate even further 15 to 20 years down the road. Nationwide, an average of 14 cases of cervical cancer occur in women between ages 15 and 19, while an average of 123 cases occur among women ages 20 to 24, prompting concerns that most Pap smears for young women are unnecessary. It's also been found that the majority of cervical lesions—which occur in 1 in 5 Pap tests among adolescents—will resolve themselves within 3 years, while removing or burning away these legions probably raises the later risk of giving birth to a premature or underweight baby.