Cervical Cancer Screening Continuation After Abnormal Pap Smears or Cervical Cancer
Women with a history of abnormal Pap smears or cervical cancer must continue regular cervical cancer screening indefinitely, with no specific age to stop, as long as they are in reasonably good health and would benefit from early detection and treatment. 1
Screening Protocol for High-Risk Women
Women with History of Cervical Cancer
- Continue screening for life with no upper age limit for discontinuation 1
- Follow the same screening protocol as average-risk women before age 30 (annual Pap smears), then continue with that same intensive protocol after age 30 1
- The standard recommendation to stop screening at age 70 does not apply to this population 1
Women with History of CIN2/3 (High-Grade Dysplasia)
- Continue screening until 10 years of consistently normal results are documented 1
- Requires documentation of three most recent consecutive tests that were technically satisfactory and interpreted as normal/negative 1
- This 10-year surveillance period applies even after hysterectomy if the hysterectomy was performed for CIN2/3 or if absence of CIN2/3 cannot be documented 1
- Screening may extend well beyond age 65 if the 20-year post-treatment surveillance period has not been completed 1
Women Who Are Immunocompromised
This includes women with:
- HIV infection
- Organ transplantation
- Chronic chemotherapy
- Chronic corticosteroid treatment
Screening protocol: 1
- Test twice during the first year after diagnosis of immunocompromised state
- Then screen annually thereafter for life
- No specific age to stop screening 1
- For HIV-positive women specifically, obtain comprehensive gynecologic examination with Pap smear as part of initial evaluation 1
Women with In Utero DES Exposure
- Continue screening indefinitely with no age limit to stop 1
- Follow same protocol as average-risk women before age 30, then continue that protocol after age 30 1
- Continue screening even after hysterectomy for as long as they are in reasonably good health 1
Critical Distinction from Average-Risk Women
The key difference is that average-risk women aged 70 and older may choose to cease screening if they have had no abnormal/positive cytology tests within the 10-year period before age 70 and have documentation of three consecutive normal tests 1. This option does not exist for women with abnormal Pap smear history or cervical cancer history. 1
Post-Hysterectomy Considerations
When to STOP screening after hysterectomy:
- Total hysterectomy (cervix removed) for benign gynecologic disease with no history of CIN2/3 1
When to CONTINUE screening after hysterectomy:
- History of cervical cancer—continue for life 1
- History of CIN2/3—continue for 10 years of normal results 1
- History of in utero DES exposure—continue for life 1
- Cannot document absence of CIN2/3 before hysterectomy—continue for 10 years of normal results 1
- Subtotal (supracervical) hysterectomy where cervix remains—follow standard screening recommendations 1
Common Pitfalls to Avoid
Do not assume older age exempts high-risk women from screening. The guidelines explicitly state there is no specific age to stop screening for women with cervical cancer history, DES exposure, or immunocompromised status 1. The decision to continue screening should be based on overall health status and whether the patient would benefit from early detection and treatment, not chronological age alone 1.
Do not discontinue screening prematurely after treatment for high-grade lesions. Current guidelines recommend at least 20 years of surveillance after spontaneous regression or appropriate management of high-grade precancerous lesions, even if this extends screening past age 65 1.
Verify hysterectomy status and indication through surgical records. Many women incorrectly report having had a hysterectomy or are unaware whether their cervix was removed 1. Direct examination or review of surgical records is necessary to confirm cervical removal before discontinuing screening 1.