From the Guidelines
Women can generally stop getting Pap tests at age 65 if they have had adequate prior screening with normal results, as recommended by the American Cancer Society guidelines 1. Adequate screening means three consecutive negative Pap tests or two consecutive negative HPV/Pap co-tests within the previous 10 years, with the most recent test occurring within the past 5 years. However, women who have had a history of high-grade precancerous lesions or cervical cancer, who are immunocompromised (such as those with HIV), or who were exposed to DES in utero should continue screening beyond age 65. Women who have had a total hysterectomy (removal of the uterus and cervix) for non-cancerous reasons and have no history of cervical cancer or high-grade precancerous lesions can stop Pap testing immediately after surgery, as stated in the guidelines 1. The rationale for stopping at 65 is that cervical cancer develops slowly, and the risk of developing cervical cancer after this age is very low for women who have had regular negative screenings, while the potential harms from continued screening (anxiety, unnecessary procedures) increase. Some key points to consider when deciding to stop Pap tests include:
- The patient's overall health and life expectancy
- Their history of cervical cancer or precancerous lesions
- Their immune status
- Their history of exposure to DES in utero
- The results of their previous Pap tests and HPV/Pap co-tests, as recommended by the guidelines 1. It's essential to note that these guidelines are based on the most recent and highest-quality evidence available, and healthcare providers should use their clinical judgment when making decisions about cervical cancer screening for their patients, as stated in the guidelines 1.
From the Research
Cervical Cancer Screening Guidelines
- The American journal of preventive medicine study 2 suggests that routine cervical cancer screening may be discontinued for average-risk women aged >65 years if "adequate" screening with negative results is documented.
- However, screening is recommended after age 65 years for women who do not meet adequate prior screening criteria or are at special risk.
Age-Based Discontinuation Recommendations
- The United States Preventive Services Task Force (USPSTF) recommends that women with adequate prior screening and average cervical cancer risk discontinue routine cervical cancer screening after age 65 3.
- A study published in Preventive medicine 4 found that screening remains common among US women over 65 years old, and that healthcare providers may need additional education on current guidelines regarding indications for Pap smears in this age group.
Screening History and Cervical Cancer Diagnosis
- A study published in Gynecologic oncology 5 found that most cervical cancers diagnosed at age 65 and older occur in women who have not met the criteria for stopping screening.
- The study also found that a few cancers will continue to occur at age 65 and older despite multiple negative tests, as is true in other age groups.
Pap Test Rates and Age
- A study published in Preventive medicine 3 found that the USPSTF recommendation to discontinue cervical cancer screening after age 65 leads to a sharp decline in Pap test rates at age 66.
- The decline in Pap test rates varied by race/ethnicity, education, and marital status, with non-Hispanic Black women not experiencing a discrete change in Pap rates at age 66 3.
Special Considerations
- A study published in the Journal of the American Geriatrics Society 6 found that primary care physicians should continue Pap screening in older women, including those with a history of hysterectomy, until a history of repeated, technically adequate, normal Pap smears is documented.
- The study also found that women with a history of abnormal Paps were far more likely to be screened, and that those who had had a hysterectomy were significantly less likely to be screened.