Should a 64-Year-Old Woman with Prior Abnormal Pap Results Undergo Pap Testing?
Yes, a 64-year-old woman with a history of abnormal Pap tests should continue cervical cancer screening and cannot stop at age 65 unless she meets very specific criteria that likely do not apply given her abnormal history. 1, 2
Key Decision Points for This Patient
Continue Screening Because:
Women with a history of abnormal Pap results require extended surveillance. If she had CIN2, CIN3, or adenocarcinoma in situ, she must continue routine screening for at least 20 years after treatment, even if this extends screening well past age 65. 3, 2
At age 64, she has not yet reached the minimum age threshold for stopping screening. Both the USPSTF (age 65) and ACS (age 70) recommend continuing screening until these ages are reached. 1, 3
The history of abnormal results disqualifies her from early cessation. To stop screening at age 65, she would need documentation of 3 consecutive negative Pap tests OR 2 consecutive negative cotests within the past 10 years, with the most recent test within the past 5 years, AND no history of CIN2+ within the last 20 years. 1, 2, 3
Recommended Screening Approach at Age 64
For women aged 30-65 (including this 64-year-old), the preferred screening strategy is:
- Co-testing with Pap plus HPV DNA test every 5 years (preferred), OR 1, 2
- Pap test alone every 3 years (acceptable alternative) 1, 2
The co-testing approach provides the most reassurance and allows for longer intervals between screenings if results are negative. 4
Special Considerations for Women with Prior Abnormalities
If She Had HPV-Negative ASC-US:
She cannot exit screening at age 65 with just this result. Data from Kaiser Permanente Northern California show that women aged 60-64 with HPV-negative ASC-US have disproportionately higher cancer risk compared to those with negative cotests, despite low dysplasia risk. 4
She should be retested in 3 years (not 5 years) and continue surveillance until she has 2 consecutive negative cotests or 3 consecutive negative Pap tests. 4
If She Had Higher-Grade Abnormalities:
Women with ASC-H, LSIL, or HSIL require colposcopy and ongoing surveillance according to ASCCP guidelines. 4
The 20-year rule applies: If she had CIN2/3, screening must continue for at least 20 years after treatment, regardless of age. 3
Critical Pitfalls to Avoid
Do not assume adequate prior screening based on patient self-report. Many women erroneously believe they had a Pap test when only a pelvic examination was performed. 4
Do not stop screening at age 65 without documented evidence of 3 consecutive negative tests AND no history of CIN2+ in the past 20 years. 1, 2
Do not use a single HPV-negative ASC-US result as justification to stop screening in women approaching age 65, as cancer risk remains elevated in this group. 4
Evidence Supporting Continued Screening in This Population
Research shows that 25% of new invasive cervical cancer cases occur in women aged 65 and older, yet only 52% of this population has had cervical cytology within the past 3 years. 5 Studies of elderly urban women found abnormal Pap smear rates of 31.5 per 1000 in women over 65, with the highest rates of advanced lesions in the 65-70 age group. 5
Women who have never been adequately screened have a 2.7 to 4 times greater incidence of cervical cancer compared to those with at least one prior normal Pap smear. 6 Given this patient's history of abnormal results, she falls into a higher-risk category requiring continued surveillance.
When Can She Eventually Stop Screening?
She may discontinue screening only after meeting ALL of these criteria: 1, 2, 3
- Reaches age 65 (USPSTF) or age 70 (ACS)
- Has 3 consecutive negative Pap tests OR 2 consecutive negative cotests within the past 10 years
- Most recent test occurred within the past 5 years
- No history of CIN2+ within the past 20 years
- Once stopped, screening should not resume for any reason, even with a new sexual partner 1, 3
Given her history of abnormal Pap tests, she likely needs to continue screening well beyond age 65, potentially until age 85 or later if she had CIN2/3. 3