Cervical Cancer Screening Interval for Elderly Women with Normal Pap Smear
An elderly woman with a normal Pap smear should return for screening every 3 years until age 65-70, after which screening can be discontinued if she has had 3 consecutive negative tests in the past 10 years. 1
Age-Based Screening Algorithm
For Women Under Age 65
- Continue screening every 3 years with Pap test alone, or every 5 years if using HPV co-testing (for women aged 30-65) 1, 2
- The 3-year interval is supported by strong evidence showing that more frequent screening (every 1-2 years) improves effectiveness by less than 5% 2
For Women Age 65-70: Criteria for Stopping Screening
Stop screening if ALL of the following are met:
- Age ≥65 years AND 1
- 3 consecutive negative Pap tests OR 2 consecutive negative co-tests within the past 10 years AND 1
- Most recent test within the past 5 years AND 1
- No history of CIN2+ (moderate or severe dysplasia) in the past 20 years 1, 3
The rationale is compelling: among well-screened women over 65, cervical cancer incidence is only 3 cases per 100,000, and continued screening reduces mortality by merely 0.06-0.18% 1
For Women Over Age 70
- Screening should be discontinued if the above criteria are met 4, 1
- Once stopped, screening should never resume, even with a new sexual partner 1
Critical Exceptions Requiring Continued Screening Beyond Age 65-70
Continue screening indefinitely if ANY of the following apply:
High-Risk Medical History
- History of CIN2, CIN3, or adenocarcinoma in situ: Continue screening for at least 20 years after treatment, even past age 65 1, 3
- HIV infection or immunosuppression (transplant recipients, chronic steroid use) 4, 3
- History of cervical cancer 3
Inadequate Prior Screening
- Never been screened or inadequately screened: Perform at least 2 negative tests one year apart, regardless of age 4, 1
- Women never screened have 3-4 times higher disease incidence than those with one prior normal test 4, 1
- Cannot document adequate prior screening 1
Other Risk Factors
- Multiple sexual partners 4, 3
- History of human papillomavirus (HPV) 4, 3
- Current smoking 4, 3
- Pessary use 4, 3
- High-risk ethnicity (Vietnamese or Hispanic women have elevated cervical cancer rates) 1, 3
Common Pitfalls to Avoid
Annual screening is excessive and not recommended - The majority (55%) of American women undergo annual Pap smears despite guidelines recommending 3-year intervals 5. This leads to unnecessary costs, patient discomfort, and false-positive results requiring additional procedures 1, 2
Under-screening high-risk populations - Between 28-64% of women over 65 have never had a Pap smear or haven't been screened within 3 years, particularly among ethnic minorities, those with less education, and those with limited financial resources 4. These women account for the majority of invasive cervical cancer cases in older age groups 1
Premature discontinuation in women with prior abnormalities - Women with any history of abnormal Paps require documented adequate negative screening for 20 years after resolution before stopping 1, 3
Screening after hysterectomy with cervical removal - If the cervix was removed for benign reasons (not cancer or dysplasia), screening should be discontinued entirely 1, 2
Special Consideration for Documentation
Ensure written documentation of screening results, as self-reports are often inaccurate 2. If prior screening history cannot be verified, perform screening tests until cessation criteria are definitively met 1