In light of recent research confirming that human papillomavirus (HPV) is a risk factor for cervical cancer, the National Cancer Institute (NCI) released revised Pap-screening guidelines last February. Here are some of the things you should know.

When should I be tested?
Women should have a Pap test for the first time three years after they begin sexual activity or at age 21, whichever comes first—a change from previous recommendations to begin screening at age 18. Experts recommend waiting three years following initiation of sexual activity because transient HPV infections and insignificant cervical-cell changes are common, and it takes years for significant abnormalities or cancer to develop. Cervical cancer is also extremely rare in women under age 25.

How often should I be tested?
You should have a screening at least every three years, although annual screening is preferable until a woman has had three or more consecutive normal results. The American Cancer Society recommends annual screening until age 30 and screening once every two to three years afterward. Women at higher-than-average risk of cervical cancer because of factors such as HIV infection should seek medical advice regarding frequency of screenings.

Is my monthly cycle a factor?
The timing of your Pap test is important. NCI guidelines say the best time to schedule your Pap test is between 10 and 20 days after the start of your last menstrual period. Naturopathic family practitioner Kristy Fassler, ND, DHANP, of Portsmouth, New Hampshire, however, recommends seven to ten days or 18 to 28 days after the start of your period, so the increased amount of mucus during ovulation won't affect specimen quality. If your appointment for a physical doesn't coincide with this, ask whether you can return for your Pap test, usually a quick procedure, at a better time in your cycle. Also, avoid douching and using spermicides or vaginal medicines two days prior to testing to avoid interfering with specimen quality.

Who doesn't need to be tested?
Screening isn't required for women who have had a total hysterectomy for a noncancerous condition. Nor is screening required for women 65 and older who have had normal Pap tests and aren't otherwise at increased risk for cervical cancer. "Many women stop coming for Pap tests after they've had children," notes Carole Hicks, ARNP OB-GYN, site manager of the Planned Parenthood Health Center in Portsmouth, New Hampshire. "Perhaps they've had a tubal ligation or stopped using birth control and think the need for screenings is behind them." But regardless of her state of fertility or sexual activity, to be safe, every woman should continue to receive regular Pap screening until she is 65 or older. That's because a significant number of women develop cervical cancer in their 50s and 60s, says Hicks.

—P.E.R.