At what age should women start cervical cancer screening?

Cervical cancer screening recommendations suggest that women should start screening at age 21, regardless of their sexual history. This guideline is based on the understanding that cervical cancer is primarily associated with persistent infection with high-risk human papillomavirus (HPV) types, which typically take many years to develop into cancer. Starting screening at this age allows for early detection of precancerous changes without subjecting younger women to unnecessary screening, considering that HPV infections are common in younger populations and often resolve spontaneously.

The recommendation is designed to balance the benefits of early detection with the risk of over-treatment for transient HPV infections that are likely to clear on their own. This rationale supports the guideline that all women should begin regular screening by the age of 21, rather than linking the start of screening to sexual initiation or activity. As women age and their risk factors change, additional guidelines become relevant related to the frequency and types of tests performed.