Decrease pap smears in women under 21 years of age

The Physician Alliance is committed helping provide appropriate use of healthcare services and tests to improve patient care, while also working to lower costs. As part of BCBSM’s Resource Stewardship Initiative, our physician organization identified three key targets for reduction in utilization by our physicians based on current physician scores and TPA’s ranking among other physician organizations in these specific areas. 



Decreasing Pap smears in women under age 21 (this is also a HEDIS metric) is one of the focus areas for The Physician Alliance. 

The incidence of cervical cancer in the United States has decreased more than 50 percent in the past 30 years because of widespread screening with cervical cytology. The American Cancer Society, U.S. Preventative Services Task Force, and American College of Obstetricians and Gynecologists agree that cervical cancer is preventable in most cases because of effective screening tests.

Proper screening must be balanced with ensuring too much testing isn’t occurring in patients. Cervical cancer prevalence declined for women over age 40. Many reputable studies indicate that the Pap smear is an over-utilized test in the United States. Health plans are working with medical societies and physician organizations on quality and outcome guidelines that lead to fewer unnecessary tests and procedures. The Pap smear has been identified as being unnecessary more than 40 percent of the time, according to a study in the Journal of Managed Care. 

 The following guidelines are now recommended for Pap smear tests:

  • Women below age 21: No Pap or HPV screening.
  • Women ages 21 to 29: Pap every three years; no HPV testing.
  • Women ages 30 to 65: Pap with HPV every five years (preferred) or Pap alone every three years.
  • Women after age 65: Discontinue Pap screening (women with previous negative PAP smear).
  • Don’t perform screening in women who have had a hysterectomy for benign disease.



TPA created a flyer focused on Pap smear testing 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: The American Cancer Society, U.S. Preventative Services Task Force, and the American College of Obstetricians and Gynecologists,