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Pap test is one more milestone for age 21

Reaching your 21st birthday is a milestone. And while preventive health screenings might not be top of mind at 21, it’s the recommended age for females to begin getting a Pap test.

A Pap test, or Pap smear, is a procedure used to detect cervical cancer. It collects a few cells from the cervix that are analyzed in a lab. Regular screenings can help detect cancer in its earliest, precancer stages. This is important because it’s when it can be treated most successfully.

WellTuned spoke with Dr. Edwin Thorpe, a medical director for BlueCross BlueShield of Tennessee, about the importance of Pap smears in the early detection and prevention of cervical cancer, including younger females.

What the recommendations say

The U.S. Preventive Services Task Force (USPSTF) issues evidence-based recommendations about important health matters. This includes cancer screenings. The task force’s cervical cancer screening recommendation calls for women ages 21 to 29 to get a Pap test every three years.

Females over 29 should get regular Pap tests, too. Here’s what the USPSTF recommends for females between the ages of 30 and 65 years:

  • screening every three years with cervical cytology alone,
  • every five years with high-risk human papillomavirus (hrHPV) testing alone,
  • or every five years with hrHPV testing in combination with cytology (cotesting).

Dr. Thorpe: Experts developed these recommendations. They take into account age and health history, as well as a greater understanding of the human papilloma virus (HPV).

HPV causes more than nine out of every 10 cases of cervical cancer, according to the Centers for Disease Control and Prevention (CDC). The immune systems of younger females, those under 21, have the ability to neutralize or “clear” HPV infections at the sight of infection. That’s why recommendations for screening now begin at age 21.

Benefits of screening

Dr. Thorpe: Cervical cancer can be curable if detected at the early, “precancer” stage. We have a variety of treatment methods to accomplish this. And surveillance testing (much like a pap smear) is used after treatment to make sure that the treatment has been successful and the cancer has not come back. This may continue for several years, depending on the severity of the condition. Most “low-grade” conditions do not warrant active treatment. They’re monitored by “watchful waiting.” But “high-grade” conditions do warrant more aggressive treatment.

But this treatment is most effective when the cancer is at that early stage. This makes screening, even at age 21, important for detection and optimal treatment outcomes.

Boosting cervical cancer screening rates in the future

According to the National Cancer Institute, 73.5% of females between the ages of 21 and 65 years were up-to-date with cervical cancer screening in 2019. So, there’s definitely room for improvement. The Healthy People 2030 goal is to boost that figure to 83.4%.

Here in the Volunteer State, the rate of cervical cancer has declined in recent years. But Tennessee has slightly higher-than-average cervical cancer rates than the national average, per the National Cancer Institute. The Cervical Cancer Free Tennessee (CCFTN) Initiative is working to eliminate cervical cancer by 2040. One way to make progress is to encourage young females to get screened for cervical cancer as appropriate for their age.

Don’t forget about vaccination

Dr. Thorpe: Pap tests are just one strategy in the fight against cervical cancer. Vaccination for HPV has the potential to essentially eliminate cervical cancer. It can also reduce the incidence of a host of other genital tract and HPV-related cancers.

The  Advisory Committee on Immunization Practices (ACIP) and the American College of Obstetricians and Gynecologists (ACOG) recommend that people receive the HPV vaccination in early adolescence before they’re exposed to HPV through sexual activity. Typically, they suggest aiming for around age 11 to 12, although it can be given earlier.

However, the vaccine is licensed for use in both males and females though the age of 45. So, if you or someone you love has not been vaccinated and you’re under age 45, there’s still time. Contact your primary care provider and discuss whether the vaccine is appropriate for you, given your age and health history.

“Vaccines and screenings are prudent and accessible tools in an overall strategy of preventive care,” Dr. Thorpe says. “They can protect us from and identify issues before they become serious or life threatening.”

More from Dr. Thorpe on WellTuned.

Jennifer Larson

Jennifer Larson is Nashville-based writer and editor with nearly 20 years of experience. She specializes in health care and family issues.

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BlueCross BlueShield of Tennessee members can access wellness-related discounts on fitness products, gym memberships, healthy eating and more through Blue365®. BCBST members can also use tools and resources to help improve health and well-being by logging into BlueAccess and going to the in the Member Wellness Center under the Managing Your Health tab.

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