When should a 66-year-old woman with a normal previous history and a new sexual partner undergo a Pap (Papanicolaou) smear?

Cervical Cancer Screening for a 66-Year-Old Woman with a New Sexual Partner

A 66-year-old woman with a normal previous history and a new sexual partner does not need to resume cervical cancer screening if she has had adequate negative prior screening and no history of CIN2+ within the past 20 years. 1, 2

Rationale for No Additional Screening

The American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology (ACS/ASCCP/ASCP) guidelines clearly state that women over 65 years of age with adequate negative prior screening should not resume screening for any reason, even if they report having a new sexual partner 1. This recommendation is based on several key factors:

• The prevalence of CIN2+ is low in well-screened women older than 65 years 1
• Cervical cancer is rare in this population when they have been adequately screened 1
• The extended natural history of HPV infection makes it improbable that new infections at this age will progress to invasive cancer within the woman's lifetime 1
• The potential harms of screening in this population include discomfort during sampling, false-positive results, and unnecessary procedures 1, 3

Definition of Adequate Prior Screening

Adequate negative prior screening is defined as:

• 3 consecutive negative cytology results OR
• 2 consecutive negative cotests (cytology plus HPV testing)
• Within the 10 years before ceasing screening
• With the most recent test occurring within the past 5 years 1, 2

Exceptions to This Recommendation

Screening should continue beyond age 65 in the following circumstances:

1. Women with a history of CIN2, CIN3, or adenocarcinoma in situ within the past 20 years 1, 2
2. Women without documented adequate negative prior screening 1, 2
3. Women who were exposed to diethylstilbestrol (DES) in utero 1, 2
4. Immunocompromised women (including HIV+) 1, 2

Follow-up After Treatment for High-Grade Lesions

For women with a history of CIN2, CIN3, or adenocarcinoma in situ:

• Routine screening should continue for at least 20 years after treatment or spontaneous regression
• This applies even if screening extends beyond age 65 1, 2

Evidence Supporting This Recommendation

Mathematical modeling shows that continuing screening beyond age 65 in well-screened women prevents only a small number of cancer cases and deaths, while resulting in a significant number of false positives and unnecessary procedures 2. One study found that for every 1000 women with a screening Pap smear over age 65,39 had at least one downstream intervention within eight months, including seven women who underwent colposcopy and two women who had other surgical procedures 3.

The risk-benefit ratio strongly favors discontinuing screening in women over 65 with adequate prior negative screening, regardless of new sexual partners, as the potential harms outweigh the minimal benefits in this specific population.