Do You Need a Pap Smear at Age 66?
No, you do not need to continue Pap smear screening at age 66 if you have had adequate prior screening with normal results. 1, 2, 3
When to Stop Screening: The Clear Criteria
You can safely discontinue Pap smear screening if you meet ALL of the following conditions:
- Age 65 or older 1, 2, 3
- At least 3 consecutive negative Pap tests OR 2 consecutive negative HPV and Pap co-tests within the past 10 years 1, 2, 3
- Most recent test occurred within the past 5 years 1, 2, 3
- No history of high-grade precancerous lesions (CIN2, CIN3) or cervical cancer 2
The evidence supporting this recommendation is robust. The USPSTF provides high certainty that for women over 65 with adequate prior screening, the benefits of continued screening do not outweigh potential harms. 2, 3 A large Swedish prospective study found that cervical cancer incidence in women age 70 and older with at least one normal Pap smear in the previous 10 years was only 3 cases per 100,000—a rate low enough to justify stopping screening. 1, 2
Critical Exceptions: When You MUST Continue Screening
You should continue screening beyond age 65-66 if any of the following apply:
- History of CIN2, CIN3, or adenocarcinoma in situ: Continue routine screening for at least 20 years after treatment, even if this extends past age 65. 2
- Never been adequately screened: If you cannot document adequate prior screening (3 negative Paps or 2 negative co-tests in the past 10 years), you need at least 2 negative Pap smears 1 year apart before stopping. 1, 2
- HIV infection or immunosuppression 1, 2
- History of multiple sexual partners or HPV infection 1, 2
- Current smoking 1, 2
- Pessary use 1, 2
- High-risk ethnicity (Vietnamese or Hispanic women have higher cervical cancer rates) 1, 2
Women who have never been screened have a cervical cancer incidence 3-4 times higher than those with at least one prior normal Pap smear. 1, 2 Between 28-64% of women age 65 and older in the United States have never had a Pap smear or have not had one within 3 years, which accounts for the high rate of invasive disease found in older women. 1, 2
Additional Considerations
If you've had a hysterectomy: You should stop Pap screening if your cervix was removed for benign reasons (not for cervical cancer or precancerous lesions). 1, 2, 3
Once screening is discontinued, it should not resume for any reason, even if you report having a new sexual partner. 2 This is because in well-screened women older than 65 years, cervical cancer is rare, and based on the extended natural history of the disease, it is improbable that incident HPV infections after age 65 will have sufficient time to progress to invasive cancer in your lifetime. 2
Why Guidelines Recommend Stopping at 65
The recommendation to stop screening is based on evidence showing 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. 2 The potential harms—including discomfort during sampling, false-positive results leading to unnecessary colposcopies, and anxiety—outweigh these minimal benefits. 2, 3
Common Pitfall to Avoid
Do not continue screening if you meet the standard cessation criteria simply because "it can't hurt." The American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology all emphasize that once screening is discontinued in adequately screened women over 65, it should not resume for any reason. 2 Over-screening increases costs and potential harms without significantly improving cancer detection. 4