What are the cervical cancer screening recommendations for a 72-year-old?

Cervical Cancer Screening Recommendations for a 72-Year-Old Woman

Women over 65 years old should discontinue cervical cancer screening if they have had adequate prior screening with normal results and are not at high risk for cervical cancer. 1, 2

Criteria for Discontinuing Screening at Age 72

Adequate Prior Screening Defined As:

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

High-Risk Factors Requiring Continued Screening:

• History of high-grade precancerous lesion (CIN2+) or cervical cancer within the past 25 years
• HIV infection
• Immunocompromised status
• In utero exposure to diethylstilbestrol (DES)
• Inadequate prior screening 1

Evidence Supporting Discontinuation at Age 72

The risk of cervical cancer is extremely low in properly screened older women. A large Swedish study found that women over 70 who had at least one normal Pap smear in the previous 10 years had only three cases of cervical cancer per 100,000 women 1. More recent research confirms that the 5-year risk of cervical precancer (CIN3) after one, two, and three consecutive negative cotests in women aged 55-64 was only 0.034%, 0.041%, and 0.016%, respectively - all significantly below the proposed risk threshold for a 5-year screening interval 3.

Common Pitfalls in Screening Older Women

1. Discontinuing screening without meeting criteria: Many women over 65 stop screening despite not meeting the criteria to do so 4. Ensure adequate documentation of prior screening.

2. Continuing unnecessary screening: About 40.8% of women over 70 had a Pap smear within the past 3 years, with 39.7% reporting receiving a provider recommendation for screening 5. This represents potential overscreening.

3. Misunderstanding risk in adequately screened women: The risk of invasive cancer among women over 65 who have been adequately screened is extremely low at approximately 2.3-4.2/100,000/year 6.

Decision Algorithm for a 72-Year-Old Woman

1. Review screening history:

   • If documentation shows adequate prior screening (as defined above) → Discontinue screening
   • If inadequate documentation or inadequate prior screening → Continue screening

2. Assess risk factors:

   • If any high-risk factors present → Continue screening
   • If no high-risk factors → Proceed based on screening history

3. Consider life expectancy:

   • Cervical cancer screening may be discontinued in individuals of any age with limited life expectancy 1

4. Hysterectomy status:

   • If total hysterectomy with removal of cervix for benign reasons → No screening needed
   • If cervix intact or hysterectomy was for cervical neoplasia → Follow standard guidelines

The American Cancer Society, USPSTF, and other major organizations are aligned in recommending cessation of screening at age 65-70 for women with adequate prior screening and no high-risk factors 1, 2. This recommendation balances the minimal benefit against the potential harms of continued screening in this age group.