Can a Pap smear be performed on a 65-year-old woman with a history of abnormal results in 2010 and a previously removed Human Papillomavirus (HPV) lesion?

From the Guidelines

Yes, a Pap smear can be performed on a 65-year-old woman with a history of abnormal results in 2010 and a previously removed Human Papillomavirus (HPV) lesion, as her history of abnormal findings and HPV lesion removal indicates she should continue screening beyond the typical age of 65.

Key Considerations

• The American Cancer Society recommends that women with a history of abnormal results or HPV infection continue screening for at least 20 years after the abnormality, even if this extends beyond age 65 1.
• The US Preventive Services Task Force (USPSTF) recommends against screening for cervical cancer in women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer 1.
• However, women with a history of abnormal results or HPV infection are considered high-risk and should continue screening beyond age 65.

Screening Recommendations

• The screening should include both a Pap test and HPV testing (co-testing) every 5 years, or Pap testing alone every 3 years 1.
• The patient should discuss with her healthcare provider the specific screening schedule based on her complete medical history and risk factors.

Rationale

• Prior HPV infection and abnormal results increase the risk of developing cervical cancer later in life, making continued screening necessary for early detection and treatment.
• The American Cancer Society and other medical organizations prioritize continued screening for women with a history of abnormal results or HPV infection to reduce the risk of cervical cancer mortality and morbidity 1.

From the Research

Cervical Cancer Screening Guidelines

• The US Preventive Services Task Force (USPSTF) recommends cervical cancer screening in women ages 30 to 65 using one of three strategies: cytology every 3 years, testing for high-risk types of human papillomavirus (hrHPV) every 5 years, or cytology plus hrHPV testing (co-testing) every 5 years 2.
• Women aged 65 years and above with a previous history of regular Pap smears may not be advised to undergo screening, according to some international professional societies 3.

Screening in Elderly Women

• A study found that the prevalence of abnormal Pap smears was higher in elderly urban women than in prior studies, suggesting that Pap smear screening may be beneficial beyond the age of 65, especially in women with a history of abnormal results 4.
• Another study reported a rare case of HPV-53-related cervical cancer in a 79-year-old woman with a previous history of negative Pap cytology, highlighting the importance of molecular tests to increase sensitivity of Pap smears in postmenopausal women 3.

Screening Intervals and Recommendations

• Guidelines recommend screening for cervical cancer among women 30 years or older 3 years after a normal Papanicolaou test result or a combined normal screening result (normal Pap/negative human papillomavirus test results) 5.
• A study found that most primary care physicians did not recommend extending screening intervals to 3 years with an HPV co-test, and that physician specialty was strongly associated with guideline-consistent recommendations for the next Pap or HPV test 5.
• Trends over time show an increase in Pap-HPV co-testing among women aged 30-65 years, from 10.0% in 2007 to 60.8% in 2016, suggesting increasing adoption of 2012 screening recommendations in this population 6.

Considerations for Women with a History of Abnormal Results

• Women with a history of abnormal Pap smear results, such as the 65-year-old woman in question, may benefit from continued screening beyond the age of 65, especially if they have not had negative screening results in the past 4.
• The presence of a previously removed HPV lesion may also be a consideration in determining the appropriate screening strategy for this woman 2, 3.