When to Stop Cervical Cancer Screening
Women should discontinue cervical cancer screening after age 65 years if they have adequate prior negative screening (3 consecutive negative cytology tests OR 2 consecutive negative cotests within the past 10 years, with the most recent test within the last 5 years) and no history of high-grade precancerous lesions or cervical cancer. 1, 2
Criteria for Stopping Screening at Age 65
Adequate prior screening is specifically defined as 1:
- 2 consecutive negative HPV tests, OR
- 2 consecutive negative cotests (HPV + cytology), OR
- 3 consecutive negative cytology tests alone
- All within the past 10 years
- With the most recent test occurring within the last 5 years
An HPV-negative ASC-US result should be regarded as negative for the purpose of meeting exit criteria 1.
Important Exceptions: Who Must Continue Screening Beyond Age 65
Women who must continue screening past age 65 include those with 1:
History of CIN2, CIN3, adenocarcinoma in situ, or cervical cancer - these women should continue routine screening for at least 20-25 years after treatment, even if this extends screening past age 65 years 1
Inadequate prior screening history - women aged >65 years without sufficient documentation of prior negative screening should be screened until cessation criteria are met 1, 3
High-risk factors including 1, 2:
- HIV infection or immunocompromised status
- In utero diethylstilbestrol exposure
- History of high-grade precancerous lesions
After Hysterectomy
Screening should be discontinued in women who have undergone 1, 2:
- Total hysterectomy with removal of the cervix for benign indications
- No history of CIN2, CIN3, adenocarcinoma in situ, or cervical cancer
Women with subtotal (supracervical) hysterectomy should continue screening following standard recommendations 1.
Clinical Context and Evidence Strength
The 2020 American Cancer Society guideline 1 extended the surveillance period for women with prior high-grade lesions from 20 to 25 years, reflecting the most recent expert consensus. This recommendation is based on the viral etiology of cervical cancer and serial negative testing indicating very low subsequent cancer risk 1.
Critical pitfall: Research demonstrates that approximately 60% of low-income older women lack adequate screening histories to safely exit screening at age 65 3. Among those who continued screening appropriately, 21.9% required biopsies and many had high-grade lesions or cancers 3. Therefore, clinicians must carefully verify adequate prior screening documentation before discontinuing screening.
The corrected incidence rate for cervical cancer among older women (accounting for hysterectomy status) does not decline until age ≥85 years 4, and modeling studies show that a 70-year-old woman with unknown screening history has a remaining lifetime risk of approximately 1 in 588 for cervical cancer 5. A negative exit HPV test reduces this risk 12.9-fold, and a negative cotest reduces it 18.1-fold 5.
Once screening is discontinued after age 65 with adequate prior screening, it should not resume for any reason, including a new sexual partner 1.