Can Pap smears (Papanicolaou tests) be performed on a 65-year-old?

From the Guidelines

Pap smears should not be routinely performed on a 65-year-old individual who has had adequate prior negative screening, defined as 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 1. However, there are exceptions to this guideline.

• Screening should continue beyond age 65 for those with a history of high-grade precancerous lesions, cervical cancer, immunosuppression, HIV infection, or inadequate prior screening.
• Women who have had a total hysterectomy (including removal of the cervix) for non-cancerous reasons and have no history of high-grade precancerous lesions do not need Pap tests. The rationale for these recommendations is that cervical cancer typically develops slowly over many years, and women with consistently negative screening results by age 65 have a very low risk of developing cervical cancer 1. Any new symptoms like abnormal bleeding should prompt evaluation regardless of age or screening history. It's also important to note that the American Cancer Society guidelines are regularly updated, and the most recent guidelines should be consulted for the latest recommendations 1. In this case, the 2019 guidelines provide the most up-to-date information on cervical cancer screening 1. Some key points to consider when deciding whether to perform a Pap smear on a 65-year-old individual include:
• The individual's prior screening history
• The presence of any high-grade precancerous lesions or cervical cancer
• The individual's immune status
• The presence of any new symptoms like abnormal bleeding
• The individual's overall health and life expectancy. By considering these factors and following the most recent guidelines, healthcare providers can make informed decisions about whether to perform a Pap smear on a 65-year-old individual 1.

From the Research

Pap Smear Recommendations for 65-Year-Old Women

• Clinical guidelines recommend that women with a history of adequate screening and not otherwise at high risk may discontinue cervical cancer screening after 65 years of age 2.
• However, screening remains common among US women over 65 years old, with 40.8% having a Pap smear within the past 3 years and 19.4% having a Pap smear in the last year 2.
• Many international professional societies no longer advise screening in women who have undergone hysterectomy, and in women aged 65 years and above, who have a previous history of regular Pap smears 3.
• The risk of precancer is less than 0.15% over 5 years following a negative HPV test result, and repeat HPV testing is recommended in 1,3, or 5 years depending on 5-year precancer risk 4.
• Recommendations to space or stop screening are often based on the perceived psychological distress of women undergoing testing and the cost of population screening, but there is limited evidence on which to base the recommendation to stop screening 5.

Considerations for Continuing Pap Smears

• Cervical cancer incidence and mortality burden are significant in women over the age of 65 5.
• Human papillomavirus (HPV) vaccination rates are poor in older women, which may increase the risk of cervical cancer 5.
• Advanced cervical cancer rates are increasing, including adenocarcinoma rates, and vulvar carcinoma rates are also increasing 5.
• Gynecological care and exams are less frequent when women are not getting routine Pap testing, which may lead to delayed diagnosis and treatment of cervical cancer 5.

Special Considerations

• HIV-infected women have higher rates of persistence of human papillomavirus (HPV) infection, of abnormal cervical cytology results, and of cervical cancer than uninfected women, and may require more frequent Pap smears 6.
• Women with a history of cervical cancer or precancerous lesions may require continued screening beyond age 65 4.