At what age can women discontinue Pap (Papanicolau) smear screening?

Age for Discontinuing Pap Smear Screening

Women should discontinue cervical cancer screening after age 65 years if they have had 3 consecutive negative cytology tests or 2 consecutive negative cotest results within the 10-year period before ceasing screening, with the most recent test occurring within the last 5 years. 1

Criteria for Discontinuing Screening

The decision to stop screening at age 65 is based on several key factors:

• Adequate prior screening history is defined as:

  • 3 consecutive negative cytology (Pap) tests OR
  • 2 consecutive negative HPV-cytology cotests within the past 10 years
  • Most recent test must have occurred within the last 5 years 1

• Once screening is discontinued, it should not resume for any reason, including if a woman has a new sexual partner 1

Special Considerations and Exceptions

Certain women should continue screening beyond age 65:

• Women with a history of CIN2, CIN3, or adenocarcinoma in situ should continue routine screening for at least 20 years after treatment, even if this extends screening past age 65 1

• Women who have not been adequately screened previously should continue screening until they meet the criteria for discontinuation 1

• Women at higher risk should continue screening beyond age 65, including those who:

  • Have a history of cervical cancer
  • Were exposed to diethylstilbestrol (DES) in utero
  • Are immunocompromised (organ transplantation, chemotherapy, chronic corticosteroid treatment)
  • Are HIV-positive 1

Women with Hysterectomy

• Women who have had a total hysterectomy with removal of the cervix and have no history of high-grade precancerous lesions or cervical cancer should discontinue screening 1

• Women who have had a hysterectomy but still have their cervix should continue screening according to age-appropriate guidelines 1

• Women who have had a hysterectomy with removal of the cervix but have a history of CIN2 or more severe diagnosis should continue screening 1

Evidence and Rationale

The recommendation to discontinue screening at age 65 is based on evidence that:

• The risk of developing cervical cancer after age 65 is very low in adequately screened women

• Modeling data suggest that continued testing of previously screened women reduces the risk of cervical cancer mortality by only 0.18% at age 65 and 0.06% at age 74 1

• However, some research suggests higher rates of abnormal Pap smears in certain elderly populations, particularly among Black women and other minority groups 2

Common Pitfalls to Avoid

1. Continuing unnecessary screening: Approximately 40.8% of women over 70 years still receive Pap smears despite guidelines recommending discontinuation 3

2. Provider-driven overscreening: Nearly 40% of women ≥70 years report receiving a recommendation for Pap testing from their provider in the past year 3

3. Stopping screening too early: Women without adequate prior screening history should not discontinue at age 65 1

4. Failing to recognize high-risk groups: Women with history of high-grade lesions or other risk factors need continued screening 1

Following these evidence-based guidelines will help optimize cervical cancer screening by balancing the benefits of early detection against the potential harms of unnecessary procedures in older women.