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In general, screening starts about the age of 20 or 25 and continues until about the age of 50 or Women should wait a few years after they first have intercourse before they start screening, and should not be screened before age American Congress of Obstetricians and Gynecologists ACOG and others recommend starting screening at age 21 since that is a few years after sexual debut for most American women.
For instance, some parts of Great Britain start screening at age ACOG's general recommendation is that people with female reproductive organs age 30—65 have an annual well-woman examination , that they not get annual Pap tests, and that they do get Pap tests at three-year intervals.
HPV is passed through skin to skin contact; sex does not have to occur, although it is a common way for it to spread.
Screening during this period may show this immune reaction and repair as mild abnormalities, which are usually not associated with cervical cancer, but could cause the patient stress and result in further tests and possible treatment.
Cervical cancer usually takes time to develop, so delaying the start of screening a few years poses little risk of missing a potentially precancerous lesion.
For instance, screening people under age 25 does not decrease cancer rates under age There is little or no benefit to screening people who have not had sexual contact.
Guidelines on frequency of screening vary—typically every three to five years for those who have not had previous abnormal smears.
Screening should stop at about age 65 unless there is a recent abnormal test result or disease. There is probably no benefit in screening people aged 60 or over whose previous tests have been negative.
There is no need to continue screening after a complete hysterectomy for benign disease. Pap smear screening is still recommended for those who have been vaccinated against HPV  since the vaccines do not cover all HPV types that can cause cervical cancer.
Also, the vaccine does not protect against HPV exposure before vaccination. Those with a history of endometrial cancer should discontinue routine Pap tests after hysterectomy.
More frequent Pap smears may be needed to follow up after an abnormal Pap smear, after treatment for abnormal Pap or biopsy results, or after treatment for cancer.
Failure of prevention of cancer by the Pap test can occur for many reasons, including not getting regular screening, lack of appropriate follow-up of abnormal results, and sampling and interpretation errors.
About one-quarter of US cervical cancers were in people who had an abnormal Pap smear but did not get appropriate follow-up patient did not return for care, or clinician did not perform recommended tests or treatment.
Adenocarcinoma of the cervix has not been shown to be prevented by Pap tests. Estimates of the effectiveness of the United Kingdom's call and recall system vary widely, but it may prevent about deaths per year in the UK.
A medical practitioner performing tests each year would prevent a death once in 38 years, while seeing people with abnormal results, referring 79 for investigation, obtaining 53 abnormal biopsy results, and seeing 17 persisting abnormalities lasting longer than two years.
At least one woman during the 38 years would die from cervical cancer despite being screened. Since the population of the UK is about 61 million, the maximum number of people who could be receiving Pap smears in the UK is around 15 million to 20 million eliminating the percentage of the population under 20 and over This would indicate that the use of Pap smear screening in the UK saves the life of 1 woman for every approximately 20, women tested assuming 15,, are being tested yearly.
If only 10,, are actually tested each year, then it would save the life of 1 woman for every approximately 15, women tested.
In the United States, about 2—3 million abnormal Pap smear results are found each year. In a typical scenario, about 0.
As liquid-based preparations LBPs become a common medium for testing, atypical result rates have increased. The median rate for all preparations with low-grade squamous intraepithelial lesions using LBPs was 2.
Rates for high-grade squamous intraepithelial lesions median, 0. Abnormal results are reported according to the Bethesda system.
Endocervical and endometrial abnormalities can also be detected, as can a number of infectious processes, including yeast , herpes simplex virus and trichomoniasis.
However it is not very sensitive at detecting these infections, so absence of detection on a Pap does not mean absence of the infection.
Micrograph of a Pap test showing a low-grade intraepithelial lesion LSIL and benign endocervical mucosa. Pap stain. Micrograph of a Pap test showing trichomoniasis.
Trichomonas organism seen in the upper right. Micrograph of a Pap test showing changes of herpes simplex virus. Endocervical adenocarcinoma on a pap test.