Originally published January 2018. Reviewed and updated August 2026 — cervical cancer screening has changed substantially since this was first written.

“How often am I supposed to get a Pap smear?” is one of the most common questions I get, and the honest answer is that it’s more complicated than it used to be — because screening got better, not because anyone is being difficult.

Here’s where things stand.

First: it may not be a Pap anymore

For years, screening meant a Pap smear — collecting cervical cells and looking at them under a microscope for changes.

We now know that virtually all cervical cancer is caused by HPV (human papillomavirus). So rather than looking for cell changes after they’ve happened, we can test for the virus that causes them. For women 30 and over, HPV testing on its own every 5 years is now the preferred approach according to the American Cancer Society and ACOG.

That’s why this article is about cervical cancer screening rather than Pap smears specifically. Same exam, often a different test.

Why screening matters

HPV is extremely common — the CDC describes it as so widespread that nearly everyone who has ever been sexually active will get it at some point. There are more than 200 types; about a dozen high-risk types can cause cancer, with types 16 and 18 responsible for around 70% of cervical cancers.

Most HPV infections clear on their own without ever causing trouble. The point of screening is to catch the small proportion that persist and start changing cells, long before those changes become cancer. Cervical cancer is one of the most preventable cancers there is — and in the US, screening is the main reason it has become uncommon.

How often, by age

Under 21: no screening. Not even if you’re sexually active. HPV is common at this age and almost always clears on its own; screening finds changes that would have resolved and leads to procedures that can affect future pregnancies.

21 to 29: a Pap (cytology) every 3 years. One note on the start age: the American Cancer Society now recommends starting at 25 rather than 21, while the US Preventive Services Task Force and ACOG still start at 21. That disagreement is genuine and unresolved — so this is worth a conversation with us about which makes sense for you.

30 to 65: three acceptable options —

• HPV test alone every 5 years — now the preferred option
• HPV and Pap together (co-testing) every 5 years
• Pap alone every 3 years — the fallback where HPV testing isn’t available

Over 65: you may be able to stop, if you’ve had adequate normal screening in the prior 10 years (with the most recent within the last 5) and no history of significant abnormal results, cervical pre-cancer, or cervical cancer. If you don’t meet those conditions — or you’ve never been screened — screening should continue. Talk to us rather than assuming.

These intervals are for routine screening in women at average risk. If you’ve had an abnormal result, been treated for cervical pre-cancer, have a weakened immune system, or were exposed to DES before birth, you need closer follow-up on a different schedule.

You may be able to collect the sample yourself

This is the biggest change since this article was first written, and it matters most for women who’ve been putting screening off.

The FDA has approved self-collected HPV sampling — you collect a vaginal swab yourself, in a private room, without a speculum exam. There are also now at-home options ordered through telehealth.

Two things to know. A self-collected sample is a vaginal sample, not a cervical one, so if HPV is detected you’ll need to come in for a proper exam to see what’s going on — it’s a screening shortcut, not a complete substitute. And a negative self-collected test is generally repeated in 3 years rather than 5. Clinician collection is still preferred where it’s an option. But if the alternative is not being screened at all, self-collection is a very good alternative.

The part we never mentioned: vaccination

The original version of this article talked about screening for HPV-caused cancer without ever mentioning that you can be vaccinated against HPV in the first place. That was a real omission.

HPV vaccination is routinely recommended at ages 11–12 (it can start at 9), with catch-up vaccination through age 26 for anyone not already vaccinated. Between 27 and 45 it’s a shared decision — some adults still benefit, and it’s worth asking. Fewer doses are needed when the series starts before age 15.

The vaccine prevents infection; it doesn’t treat one you already have. And being vaccinated does not mean you can skip screening — it covers most cancer-causing types, not all of them. We give the HPV vaccine here; ask at your next visit.

What else happens at that appointment

If you’re under 25 and sexually active, we’ll usually also test for chlamydia and gonorrhea, which are common and often silent. That’s a simple swab you can collect yourself in our bathroom.

More than anything, that visit is a yearly chance to talk about whatever’s on your mind — and things patients bring up sideways at the end of an appointment are often the things that matter most. Preventive visits are typically covered by insurance at no cost to you, though it’s worth checking your specific plan; you can see the plans we accept on our Insurance & Billing page.

Come see us

If you’re overdue — and a lot of women are — please just call. We’re an all-female clinical staff, we know this exam is nobody’s favorite, and we do our best to make it quick and comfortable. You can read more about our wellness visits, or call (417) 332-3639.

As always, I hope you stay happy and healthy.

Carolyn Clark, NP-C