At what age does cervical cancer screening typically end?

Cervical Cancer Screening Cessation Guidelines

Cervical cancer screening should be discontinued in women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer. 1

Definition of Adequate Prior Screening

Adequate prior screening is defined as:

• 3 consecutive negative cytology results OR
• 2 consecutive negative HPV/cytology cotests within the past 10 years, with the most recent test performed within the past 5 years 1

High-Risk Exceptions (Screening Should Continue)

Screening should continue beyond age 65 in women who:

• Have a history of CIN2+ (cervical intraepithelial neoplasia grade 2 or higher) in the past 25 years 1
• Have a history of cervical cancer
• Are immunocompromised (such as HIV positive)
• Had in utero exposure to diethylstilbestrol (DES)
• Have not been adequately screened previously 1

Screening After Hysterectomy

• Women who have had a total hysterectomy with removal of the cervix and who do not have a history of CIN2+ or cervical cancer should not undergo cervical cancer 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 for CIN2+ should continue vaginal cuff cytology screening until they have three consecutive negative tests with no abnormal results within a 10-year period 2

Evidence Supporting Cessation at Age 65

The recommendation to stop screening at age 65 is based on several key findings:

1. Low incidence of new cases: The risk of developing cervical cancer after age 65 in adequately screened women is very low 3
2. Diminishing returns: Modeling studies show that continuing screening beyond age 65 in adequately screened women provides minimal additional benefit (only 1 life-year improvement) while increasing potential harms 1
3. Harms of continued screening: These include discomfort during sampling, false positives, and potential overtreatment 1

Important Considerations and Caveats

• Unscreened women: About half of all invasive cervical cancer cases are diagnosed in women who have never been screened or have not been screened in the last 5 years 1
• Screening history verification: Clinicians should verify adequate prior screening before discontinuing screening in women over 65 1
• Documentation: Thorough documentation should include screening history and rationale for discontinuation 2
• Once discontinued: Once screening is discontinued after age 65, it should not resume for any reason, including having a new sexual partner 1

Screening Rates in Older Women

Despite guidelines, overscreening remains common in women over 65:

• Approximately 40.8% of women over 70 had a Pap smear within the past 3 years 4
• Provider recommendation is strongly associated with continued screening, suggesting that provider education about guidelines is needed 4

The decision to end screening at age 65 represents a balance between the benefits of detecting rare cancers and the harms of unnecessary procedures in women with a long history of normal screening results.