At what age can a female patient with a history of breast cancer screening and significant smoking history stop getting Pap (Papanicolau) smears for cervical cancer screening?

When to Stop Pap Smear Screening

Women should discontinue Pap smear screening at age 65 if they have had 3 consecutive negative cytology tests or 2 consecutive negative cotest results (Pap + HPV) within the past 10 years, with the most recent test occurring within the last 5 years. 1, 2, 3

Standard Cessation Criteria

The decision to stop screening is based on adequate prior negative screening documentation, not on other factors like smoking history or breast cancer screening history. 2, 3

Key requirements for stopping at age 65:

• 3 consecutive negative Pap tests alone within 10 years, OR 1, 3
• 2 consecutive negative cotests (Pap + HPV) within 10 years 1, 3
• Most recent test must be within the past 5 years 1, 2
• No history of high-grade dysplasia (CIN2/3) or cervical cancer 2, 3

Once screening is discontinued after age 65, it should not resume for any reason, even if the woman reports a new sexual partner. 2

Critical Exceptions: Continue Screening Beyond Age 65

Women with prior CIN2, CIN3, or adenocarcinoma in situ must continue routine screening for at least 20 years after treatment, even if this extends screening well past age 65 years. 1, 2, 3

Continue screening regardless of age if:

• HIV infection or immunosuppression present 2, 3
• History of organ transplantation 1
• Chronic corticosteroid treatment or chemotherapy 1
• History of in utero DES exposure 1
• History of cervical cancer 1, 2

Special Populations Requiring Consideration

Women who have never been screened or have inadequate screening documentation:

• Should receive at least 2 negative Pap smears 1 year apart before cessation, regardless of age 2
• Between 28-64% of women age 65 and older have never had a Pap smear or have not had one within 3 years 2
• Unscreened women have 3-4 times the incidence of cervical cancer compared to those with at least one prior normal Pap smear 2

Women who have had a hysterectomy:

• Total hysterectomy with cervix removal for benign reasons: stop screening immediately 1, 2, 4
• Subtotal (supracervical) hysterectomy with cervix retained: continue screening per standard guidelines 1
• Hysterectomy for cervical cancer or high-grade dysplasia: continue screening for at least 20 years post-surgery 1, 2

Evidence Supporting Age 65 Cessation

The rationale for stopping at age 65 is compelling:

• Among adequately screened women over 65, the 20-year absolute risk of cervical cancer is only 8 per 100,000, compared to 49 per 100,000 in unscreened women—an 84% risk reduction 3
• Cervical cancer incidence among women age 70 and older with at least one normal Pap smear in the previous 10 years is only 3 cases per 100,000 2
• Modeling studies show that continued screening reduces cervical cancer mortality by only 0.18% at age 65 and 0.06% at age 74 2
• The ratio of colposcopies to life-years gained becomes very large beyond age 65, indicating screening becomes inefficient 2, 3

Common Pitfalls to Avoid

Provider-driven overscreening is common:

• 40.8% of women over 70 had a Pap smear within the past 3 years despite guidelines recommending cessation 5
• Women who received a provider recommendation were 10.5 times more likely to undergo screening compared to those who did not receive a recommendation 5
• Healthcare providers need education on current guidelines to reduce unnecessary screening 5

Do not continue screening based on:

• Smoking history alone 2
• History of breast cancer screening 2
• New sexual partner after age 65 2
• Patient preference if adequate prior screening is documented 2

The context of breast cancer and smoking history mentioned in your question does not change cervical cancer screening cessation criteria—only the factors listed above (prior dysplasia, immunosuppression, inadequate screening) warrant continued screening beyond age 65. 2, 3