At what age should women be screened for cervical cancer?

• A. Pap smears start at 21 years old
• B. Pap smears start at 18
• C. Pap smears start at 30
• D. Pap smears start at 25

Answer: (A)

Screening starts at a level where the benefits of finding precancerous changes outweigh the harms of testing, particularly in young people. In cervical cancer screening, most HPV infections and mild cytologic abnormalities in adolescence and early adulthood resolve on their own, so starting screening before 21 leads to many false positives and unnecessary procedures without improving cancer outcomes. By beginning at 21, we focus on detecting lesions that are more likely to persist and potentially progress, while avoiding overdiagnosis and overtreatment in those who would naturally clear infections. Therefore, initiating Pap smears at 21 is the guideline-supported approach. Starting earlier (18) would increase unnecessary testing and interventions, and starting later (25 or 30) would delay detection of lesions that could progress if left unchecked.