Decrease Pap Tests and HPV Tests

Decrease the use of human papillomavirus (HPV) testing, alone or in combination with cytology for cervical cancer, in women younger than 30 years old and decrease unnecessary annual Pap tests in women over 30.

The Physician Alliance is committed to helping provide appropriate use of healthcare services and tests to improve patient care, while also working to lower costs by avoiding unnecessary testing.

About this measure:

HPV testing is not recommended for average-risk women. Studies have shown that unnecessary testing can cause more frequent testing and invasive diagnostic procedures such as colposcopy and cervical biopsy. Abnormal screening test results may also cause psychological harms, anxiety and distress.

In average risk women, annual Pap smear testing has not shown advantages over screening performed at 3-year intervals. However, a doctor should ask female patients about concerns and problems and perform appropriate screenings (with possible pelvic exam) during an annual well visit.

The following are screening methods for average-risk asymptomatic women recommended by the USPTF ACOG and ACS:

    • Age 21 to 29: Cervical cytology (PAP) every 3 years, regardless of age of onset of sexual activity
    • Age 30 to 65: Cervical cytology with HPV co-test every 5 years (Pap + HPV test) OR cervical cytology (without HPV co-test) every 3 years

High risk population for cervical cancer include women with a history of CIN2, CIN3, or cervical cancer, women who were exposed in utero to diethylstilbestrol, women who are infected with HIV, or women who are immunocompromised (such as those who have received solid organ transplants).


TPA created a poster focused on Pap/HPV tests that can be posted in waiting areas and exam rooms to help support conversations between physicians and patients.

Choosing Wisely, an initiative of the ABIM Foundation, is a national healthcare campaign to promote important healthcare conversations between physicians and patients. Working with national medical societies, Choosing Wisely has produced numerous tip sheets focused on physician tips and patient tips.


Sources: Centers for Disease Control & Prevention, U.S. Preventative Services Task Force, American Academy of Family Physicians, Choosing Wisely