From the Guidelines
A 65-year-old woman with a history of abnormal results in 2010 and subsequent removal of a lesion should continue cervical cancer screening beyond age 65, as her history of cervical precancer or abnormal results indicates a need for ongoing monitoring. According to the guidelines from the American College of Physicians, published in the Annals of Internal Medicine in 2015 1, women with a history of cervical precancer, cervical cancer, or abnormal results should continue screening for at least 25 years after the abnormality, even if this extends beyond age 65. The screening approach might include Pap testing alone every 3 years, HPV testing alone every 5 years, or co-testing (Pap plus HPV) every 5 years, depending on the specific circumstances and provider recommendation. Some key points to consider in this case include:
- The patient's history of an abnormal Pap test and surgical intervention indicates a need for continued screening beyond age 65
- The estimated average time for a high-grade precancerous lesion to progress to cervical cancer is 10 years, allowing ample time for identification and treatment of such lesions 1
- Cotesting, which includes cytology plus testing for high-risk HPV types, is an alternative to cytology alone in women aged 30 to 65 years, and may be considered in this patient's screening plan 1
- The details of her 2010 abnormality, the procedure performed, and any subsequent screening results should be reviewed to determine the most appropriate screening plan going forward. It is essential to weigh the benefits and harms of continued screening in this patient, considering her individual risk factors and medical history, to determine the best approach for her care.
From the Research
Pap Smear Screening for a 65-Year-Old Woman
- A 65-year-old woman with a history of abnormal results in 2010 and subsequent removal of a lesion can still undergo a Pap smear screening, as there is no upper age limit for cervical cancer screening 2.
- The risk of cervical lesions in women with a history of abnormal Pap smears is higher, and regular screening is essential to detect any potential abnormalities early 3.
- A study found that the sensitivity, specificity, positive predictive value (PPV), and negative predictive value of Pap smear were 77.80%, 100%, 100%, and 97%, respectively, considering cervical biopsy as the gold standard 4.
Considerations for Screening
- Women with a history of abnormal Pap smears, cervical intraepithelial neoplasia, or cervical cancer are at a higher risk of developing anal dysplasia, and anal cytology may be considered as an additional screening tool 5.
- The use of cervical cancer biomarkers, such as p16 and Ki-67, can improve the triage of abnormal Pap smears and reduce the need for unnecessary colposcopies and biopsies 6.
- Regular screening and follow-up are crucial for women with a history of abnormal Pap smears, as the risk of developing cervical cancer or precancerous lesions remains higher 2.