Cervical Cancer Screening Recommendations for a 66-Year-Old Female with a New Sexual Partner
For a 66-year-old woman with a new sexual partner who has had normal Pap tests including negative cytology and HPV co-testing at ages 59 and 63, no further cervical cancer screening is recommended.
Rationale for Discontinuing Screening
The USPSTF, American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology all recommend against cervical cancer screening in women over age 65 who have had adequate prior screening with normal results and are not otherwise at high risk for cervical cancer 1.
This patient meets the criteria for adequate prior screening:
- She has had normal Pap tests
- She had negative co-testing (cytology and HPV) at ages 59 and 63
- Her most recent screening was within the past 5 years
- She has no history of abnormal Pap tests
Key Points About Screening Discontinuation
- Definition of adequate prior screening: 3 consecutive negative cytology results or 2 consecutive negative co-tests within the past 10 years, with the most recent test occurring within the past 5 years 1
- Age cutoff: Screening should be discontinued after age 65 if adequate prior screening has been documented 1
- New sexual partner: A new sexual partner does not change the recommendation to discontinue screening after age 65 in women with adequate prior screening 2
Important Considerations
Risk assessment: The patient has no history of abnormal Pap tests, which would be a risk factor requiring continued screening 1
Once screening is discontinued: According to guidelines, "once screening is discontinued it should not resume for any reason, even if a woman reports having a new sexual partner" 1
Rationale for this approach: In well-screened women over age 65, cervical cancer is rare, and the potential harms from screening (discomfort, false positives, unnecessary procedures) outweigh the benefits 1
Extended natural history: The progression from HPV infection to invasive cancer typically takes 10+ years, making it unlikely that new infections in women over 65 with adequate prior screening would progress to cancer during their lifetime 1
Common Pitfalls to Avoid
Continuing screening unnecessarily: Many providers continue screening beyond age 65 despite guidelines, leading to unnecessary procedures and potential harms
Restarting screening due to new sexual partner: This is specifically addressed in guidelines as not being an indication to resume screening after proper discontinuation 1
Confusion about co-testing vs. cytology alone: For women aged 30-65, co-testing every 5 years was preferred over cytology alone every 3 years 1, but this patient is now beyond the recommended screening age
Misunderstanding "high risk": Having a new sexual partner does not qualify as a "high risk" factor that would warrant continued screening beyond age 65 in women with adequate prior screening 2
By following these evidence-based recommendations, unnecessary testing and potential harms can be avoided while maintaining appropriate preventive care for this patient.