At what age can you stop getting Pap (Papanicolau) smears?

When to Stop Pap Smears

Pap smear screening should be discontinued after age 65 in women who have had at least 3 consecutive negative Pap tests or at least 2 consecutive negative HPV and Pap tests within the last 10 years, with the most recent test occurring within the last 5 years. 1

Age-Based Recommendations

The discontinuation of cervical cancer screening is based on several key factors:

• Age 65+: Multiple guidelines support stopping Pap smears at age 65-70 if adequate prior screening has been documented 1
• Age 70+: The American Geriatrics Society recommends Pap tests every three years until age 70 1
• Adequate prior screening is defined as:
  • 3 consecutive negative cytology results OR
  • 2 consecutive negative HPV and Pap co-tests within the last 10 years, with the most recent test occurring within the last 5 years 1

Special Populations Who Should Continue Screening

Certain women should continue screening beyond age 65, regardless of age:

• Women with a history of cervical cancer
• Women with a history of high-grade precancerous lesions (CIN2/3)
• Women with in utero exposure to diethylstilbestrol (DES)
• Immunocompromised women (including HIV+)
• Women who have tested positive for HPV DNA
• Women who have never been adequately screened 1

After Hysterectomy

• Total hysterectomy with cervix removal for benign disease: No further Pap testing needed 1
• Subtotal hysterectomy (cervix remains): Continue screening according to age-based guidelines 1
• Hysterectomy with history of CIN2/3: Continue screening until three consecutive negative Pap tests with no abnormal results within a 10-year period 1

Rationale for Stopping at Age 65-70

1. Low incidence in properly screened women: The vast majority of cervical cancers in older women occur in those who were not previously screened or who did not have adequate prior normal results 1

2. Diminishing returns: Modeling data shows 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

3. Potential harms: Screening in older women can lead to:

   • Anxiety and discomfort during sampling
   • False-positive results leading to unnecessary procedures
   • Higher healthcare costs
   • Difficulty obtaining adequate samples due to atrophy and cervical stenosis 1

Clinical Pitfalls to Avoid

1. Stopping too early: Never discontinue screening before age 65 in average-risk women

2. Inadequate documentation: Always verify and document adequate prior screening before discontinuing

3. Ignoring high-risk factors: Women with risk factors should continue screening regardless of age

4. Misinterpreting hysterectomy status: Confirm whether the cervix was removed during hysterectomy before stopping screening

5. Overlooking new sexual partners: Older women with new sexual partners may have new HPV exposures and should continue screening 1

Remember that the decision to stop screening should prioritize the patient's overall health status and life expectancy. Women with severe comorbid or life-threatening illnesses may forego cervical cancer screening regardless of age 1.