From the Guidelines
The most appropriate recommendation for this 67-year-old woman is to discontinue cervical cancer screening, as she has no history of cervical intraepithelial neoplasia grade 2 or more severe disease within the past 25 years and has documented adequate negative prior screening in the prior 10 years. This recommendation is based on the American Cancer Society's 2020 guideline update, which states that individuals aged >65 years who meet these criteria should discontinue all cervical cancer screening 1. The patient's history of consistently normal Pap tests, including negative HPV and Pap cotesting at age 65, supports this recommendation.
Key factors in her history that support discontinuing screening include:
- Age over 65 years
- Consistently normal Pap tests throughout her life
- Negative HPV and Pap cotesting at age 65
- No history of high-grade precancerous cervical lesions or cervical cancer
- Long-term monogamous relationship, suggesting lower risk for new HPV infections
- Medical history, including the benign ovarian cystectomy, does not increase her cervical cancer risk
As noted in the 2020 American Cancer Society guideline update, continuing screening beyond age 65 in women with adequate negative prior screening provides minimal benefit while potentially causing harm through false positive results, unnecessary procedures, and patient anxiety 1. Therefore, discontinuing cervical cancer screening is the most appropriate recommendation for this patient, as it aligns with current guidelines and takes into account her individual risk factors and medical history.
From the Research
Cervical Cancer Screening Recommendations
The patient in question is a 67-year-old woman with a history of adequate cervical cancer screening and no high-risk factors. According to the guidelines, women with a history of adequate screening and not otherwise at high risk may discontinue cervical cancer screening after 65 years of age 2.
Key Considerations
- The patient's last menstrual period was at age 53, and she has had no bleeding since.
- Her Pap test and human papillomavirus (HPV) cotesting were negative 2 years ago at age 65.
- All prior Pap tests were normal.
- The patient is sexually active in a monogamous relationship and has no medical conditions.
- She has no family history of cancer.
Screening Interval Guidelines
- Guidelines recommend screening for cervical cancer among women 30 years or older 3 years after a normal Papanicolaou test (Pap test) result or a combined normal screening result (normal Pap/negative human papillomavirus [HPV] test results) 3.
- For women aged 30 years and older in routine clinical practice who are negative by co-testing (both HPV and cytology), 3-year screening intervals were safe because a single negative test for HPV was sufficient to reassure against cervical cancer over 5 years 4.
- Current screening guidelines for average-risk individuals have minor differences, but are evolving toward an HPV-based strategy 5.
Recommendation
Based on the patient's history and the guidelines, the most appropriate recommendation for cervical cancer screening in this patient is to discontinue screening, as she has had adequate prior screening and is not at high risk 2, 5.