Do women need Pap (Papanicolau) smears and HPV (Human Papillomavirus) testing at age 64?

Cervical Cancer Screening at Age 64

Women at age 64 should continue cervical cancer screening with both Pap and HPV testing until age 65, as long as they are in good health and have not had adequate prior negative screening. 1

Screening Guidelines for Women Age 64

• Women who have an intact cervix and are in good health should continue cervical cancer screening until age 70 years, after which they may elect to stop screening if specific criteria are met 1
• For women aged 30-65 (including those at age 64), the preferred screening approach is either:
  • Option 1 (preferred): Pap test plus HPV DNA test every 5 years 2
  • Option 2: Pap test alone every 3 years 2

Criteria for Discontinuing Screening at Age 65+

Women may discontinue screening after age 65 only if they meet ALL of the following criteria:

• Have had no abnormal/positive cytology tests within the 10-year period prior to age 70 years 1
• Have documentation that the 3 most recent Pap tests were technically satisfactory and interpreted as normal 1
• For women aged 65 and older, the American Cancer Society recommends that screening can be discontinued if there is evidence of adequate negative prior screening and no history of CIN2+ within the last 20 years 1

Special Considerations for Continued Screening

Screening after age 65 is specifically recommended for:

• Women in good health who have not been previously screened 1
• Women for whom information about previous screening is unavailable 1
• Women for whom there is a low likelihood of past screening 1
• Women with a history of cervical cancer or in utero exposure to DES 1
• Women who are immunocompromised (including HIV-positive women) 1

Benefits of Continued Screening at Age 64

• Continuing screening until age 65 captures 86.6% of the benefits achievable by continuing to screen until age 75 years 3
• Combined HPV and Pap testing provides greater sensitivity for detection of cervical intraepithelial neoplasia compared to Pap testing alone 4, 5
• HPV testing with Pap testing reduces the incidence of grade 2 or 3 cervical intraepithelial neoplasia or cancer detected by subsequent screening examinations 4

Patient Concerns and Education

• Studies show that many women (74.1%) still believe they should be screened annually, despite changing recommendations 6
• Only 25.2% of women are willing to extend screening intervals to 5 years, even with HPV co-testing 6
• Education should address that:
  • HPV infection is common and usually not harmful 1
  • A positive HPV test result does not indicate the presence of cancer 1
  • The majority of women who test positive for HPV will not develop advanced cervical neoplasia 1

Common Pitfalls to Avoid

• Discontinuing screening too early (before age 65) when a woman has not had adequate prior screening 2
• Over-screening, which increases costs and potential harms without significantly improving cancer detection 2
• Under-screening high-risk populations who require more frequent monitoring 2
• Failing to document screening history adequately, which may lead to unnecessary continuation or inappropriate cessation of screening 1

In summary, women at age 64 should continue with cervical cancer screening as they have not yet reached the age threshold (65) where discontinuation may be considered if they have adequate prior negative screening history. The screening approach should include both Pap and HPV testing to maximize detection of precancerous lesions.