At what age can women stop having Pap (Papanicolau) smears?

When to Stop Pap Smear Screening

Women can stop Pap smear screening at age 65-70 years if they have had adequate prior screening with normal results, specifically three consecutive negative tests in the past 10 years with the most recent test occurring within 5 years. 1

Recommendations by Major Guidelines

• The U.S. Preventive Services Task Force (USPSTF) recommends discontinuing regular Pap testing after age 65 in women who have had consistently normal results on previous tests. 1

• The American Cancer Society (ACS) recommends stopping screening at age 70 years after 3 negative tests in the last 10 years. 1

• The American College of Obstetricians and Gynecologists (ACOG) updated their guidelines in 2009 to recommend stopping screening at age 65-70 years after 3 negative tests in the last 10 years. 1

• The American Geriatrics Society (AGS) recommends Pap tests every three years until age 70. 1

Special Considerations

Women Who Have Had a Hysterectomy

• Women who have had a hysterectomy with removal of the cervix for benign reasons should discontinue Pap screening. 1

• Pap testing is not required in women who have undergone a hysterectomy in which the cervix was removed, unless the surgery was performed because of cervical cancer or its precursors. 1

Women With Inadequate Prior Screening

• Screening may be clinically indicated in older women for whom the adequacy of prior screening cannot be accurately assessed or documented. 1

• Studies reveal that between 28% and 64% of women age 65 and older in the United States have never had a pap smear or have not had one within 3 years. 1

• Women who have never had cervical screening have an incidence of disease three to four times that of women who have had at least one prior normal pap smear. 1

Women at Higher Risk

• Women with risk factors for cervical cancer may need continued screening beyond age 65-70, even with a history of adequate screening. Risk factors include: 1

  • Multiple sex partners
  • History of human papillomavirus (HPV) infection
  • HIV infection or immunosuppression
  • History of cervical dysplasia
  • Smoking
  • Pessary use

• Certain populations are at increased risk of cervical cancer, including Vietnamese women (with rates more than 2.5 times those of other racial/ethnic groups) and Hispanic women. 1

Evidence Supporting Cessation of Screening

• A large prospective study in Sweden found 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

• Modeling data suggest that continued testing of previously screened women reduces the risk of cervical cancer mortality by only 0.18% at age 65 and by 0.06% at age 74. 1

• A study of Kaiser Permanente Northern California members found that the risk of invasive cancer among women age 65 and older was 4.2/100,000/year, with most cancers occurring in women who had not met criteria for stopping screening. 2

Practical Algorithm for Deciding When to Stop Screening

1. If woman is ≥65 years old AND has had 3 consecutive negative Pap tests (or 2 consecutive negative HPV tests) within the past 10 years (with most recent test within 5 years) → Stop screening 1

2. If woman has had a hysterectomy with removal of the cervix for benign reasons → Stop screening 1

3. Continue screening beyond age 65 if:

   • Inadequate prior screening 1
   • History of cervical dysplasia or cancer 1
   • Immunocompromised status 1
   • High-risk HPV infection 3
   • Other significant risk factors 1

4. For women who have never been screened, perform at least two negative tests one year apart, regardless of age 1