No Pap Smears for Women Under 21: Guidelines

Most women should not bother getting a Pap test until they turn 21, according to the American College of Obstetricians and Gynecologists (ACOG). However, certain populations under 21 that still do need screening are detailed in new ACOG guidelines. Exceptions include women with compromised immune systems, since they cannot "fend off viral infections as easily or at all," ACOG said in a release.

"HIV-infected adolescent girls should have cervical cancer screening twice in the first year after their HIV diagnosis and once a year thereafter," ACOG said. "Sexually active adolescents who have weakened immune systems from an organ transplant or because of long-term steroid therapy also should be screened six months apart in the first year after they begin having sex and then continue with annual Pap tests."

Most women under 21 with healthy immune systems "have a better chance of winning the lottery than getting cancer at that age," said Dr. Mark Einstein, of the Albert Einstein College of Medicine, who did not work on the guidelines.

"There's no point in testing for HPV because it's so common among teens and 90 percent of HPV infections are naturally resolved by the immune system within two years," said Dr. Cheryl B. Iglesia, chair of ACOG's Committee on Gynecologic Practice.

Although most girls do not need Pap tests, they still need to continue with annual visits to their gynecologists, Iglesia said.

"Over-screening adolescents is really detrimental to young women," Einstein said. "We increase their anxiety, we increase their time away from school and work."

The guidelines, "Cervical Cancer Management in Adolescents: Screening, Evaluation, and Management," were published in Obstetrics & Gynecology (2010;116(2):469-472).

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