What are the guidelines for pap (Papanicolau test) and HPV (Human Papillomavirus) screening for a 66-year-old female with a history of normal paps and a new partner?

Cervical Cancer Screening Guidelines for a 66-Year-Old Woman with Normal Paps and a New Partner

For a 66-year-old woman with normal Pap history and a new partner, cervical cancer screening should be discontinued if she has had adequate prior screening, defined as 3 consecutive negative cytology tests or 2 consecutive negative cotests within the past 10 years, with the most recent test occurring within the past 5 years. 1, 2

Screening Recommendations for Women Over 65

When to Discontinue Screening

• Women should discontinue cervical cancer screening after age 65 if they have:
  • 3 consecutive negative cytology tests OR
  • 2 consecutive negative cotests (HPV + cytology) within the 10-year period before ceasing screening
  • With the most recent test occurring within the last 5 years 1

When to Continue Screening

Screening should continue beyond age 65 ONLY in these specific circumstances:

• History of cervical intraepithelial neoplasia grade 2 (CIN2) or more severe diagnosis within the past 20-25 years 1
• In utero exposure to diethylstilbestrol (DES) 1
• Immunocompromised status (organ transplantation, chemotherapy, chronic corticosteroid treatment, HIV positive) 1
• Insufficient documentation of adequate prior screening 1

Important Considerations for This Patient

New Sexual Partner

• Having a new sexual partner is NOT a reason to continue screening beyond age 65 if the woman has adequate prior negative screening 1
• The American Cancer Society explicitly states: "Once screening is discontinued, it should not resume for any reason, including if a woman has a new sexual partner." 1

Screening History Documentation

• If documentation of prior screening is unavailable, screening should continue until criteria for discontinuation are met 1
• Adequate prior screening is the key determinant, not new sexual partners or sexual activity

Special Considerations

Hysterectomy Status

• If the patient has had a total hysterectomy with removal of the cervix for benign reasons (not due to CIN2+ or cancer), no screening is needed 1, 2
• If she has had a subtotal (supracervical) hysterectomy, screening should continue following recommendations for average-risk women 1

History of Abnormal Results

• Women with a history of CIN2 or more severe diagnosis should continue routine screening for at least 20 years, even if screening extends beyond age 65 1

Screening Methods (If Continued Screening Is Indicated)

For women aged 30-65 years (applicable if screening must continue):

• Preferred approach: HPV testing alone every 5 years OR
• HPV and cytology cotesting every 5 years OR
• Cytology alone every 3 years 1, 3

Common Pitfalls to Avoid

1. Continuing screening unnecessarily: Many providers continue screening beyond age 65 despite adequate prior negative screening, which can lead to unnecessary procedures, anxiety, and increased healthcare costs 2

2. Restarting screening due to new sexual partners: This is explicitly not recommended by guidelines 1

3. Lack of documentation: Ensure proper documentation of screening history before discontinuing screening 1

4. Overestimating benefits: The benefits of screening women over 65 with adequate prior screening are minimal compared to potential harms 2, 3

By following these evidence-based guidelines, you can provide appropriate care while avoiding unnecessary testing for this 66-year-old patient with normal Pap history and a new partner.