When is a 61-year-old female due for her next cervical cancer screen and at what age can she stop screening in Ontario?

Cervical Cancer Screening Guidelines for a 61-Year-Old Female in Ontario

For a 61-year-old female with a negative cervical cancer screen in Ontario, her next screening should be in 3 years, and she can discontinue screening at age 70 if she has had at least two previous negative Pap smears since age 60.

Next Screening Interval

For a 61-year-old woman with a negative cervical cancer screening result, the recommended screening interval is:

• The Canadian National Workshop on Screening for Cancer of the Cervix recommends screening every 3 years until age 69 1
• This is supported by evidence showing that screening more frequently than every 3 years provides minimal additional benefit while significantly increasing potential harms 1

When Screening Can Be Discontinued

Screening can be discontinued based on the following criteria:

• In Ontario (following Canadian guidelines), screening can be discontinued at age 70 if there have been at least two previous negative Pap smears since age 60 1
• This recommendation is supported by evidence from a large prospective study showing that the incidence of cervical cancer among women age 70 and older who had at least one normal Pap smear in the previous 10 years was only three cases per 100,000 1

Risk Assessment Considerations

Several factors should be considered when determining whether to continue screening beyond age 70:

• Previous screening history: Adequate screening is defined as having at least two negative Pap tests since age 60 1
• Risk factors: Women with risk factors should continue screening beyond the usual stopping age, including those with:
  • History of CIN2+ in the past 20-25 years 2
  • History of HPV infection 1
  • HIV infection or immunosuppression 1, 2
  • In utero exposure to diethylstilbestrol (DES) 1, 2
  • Multiple sexual partners 1
  • Smoking history 1
  • Pessary use 1

Special Populations

• Women with hysterectomy: Women who have had a total hysterectomy with removal of the cervix for benign indications and no history of high-grade CIN should discontinue routine cytology testing 1
• Ethnic considerations: Some populations have higher risk of cervical cancer, including Vietnamese and Hispanic women 1

Evidence Supporting Recommendations

• Research shows that the 5-year risk of CIN3 after two consecutive negative cotests is only 0.041%, which is well below the proposed 0.12% risk threshold for a 5-year screening interval 3
• A study found that women with adequate negative screening at age 50-64 had one-sixth the risk of cervical cancer at age 65-83 compared to unscreened women 4
• The risk of invasive cancer among women age 65 and older with adequate prior screening is very low (2.3/100,000/year) 5

Potential Pitfalls and Caveats

• Underscreening: Studies indicate that 17% of women do not receive time-appropriate Pap tests, with women aged 40-69 being at higher risk of underscreening 6
• Verification of screening history: Ensure adequate documentation of previous negative screening results before discontinuing screening 2
• Life expectancy considerations: As life expectancy increases, the benefits of continued screening may outweigh the harms for some women 4
• Heterogeneous populations: Canadian guidelines are based partly on Swedish data, which may not fully account for the heterogeneity of North American populations 1

Remember that these recommendations apply to women with normal screening histories. Women with a history of abnormal results, cervical cancer, or significant risk factors may require more frequent screening or continued screening beyond the usual stopping age.