At what age can cervical screenings be stopped for a female patient of reproductive age with no high-risk factors for cervical cancer and a history of adequate prior screening with negative results?

When to Stop Cervical Cancer Screening

Cervical cancer screening should be discontinued at age 65 years if the patient has adequate prior negative screening—defined as 3 consecutive negative cytology tests OR 2 consecutive negative HPV tests OR 2 consecutive negative cotests within the past 10 years, with the most recent test within the last 5 years—and no history of high-grade precancerous lesions or cervical cancer. 1, 2

Defining "Adequate Prior Screening"

The specific criteria that must be met before stopping screening at age 65 include: 1

• 3 consecutive negative cytology tests alone within the past 10 years, OR
• 2 consecutive negative HPV tests within the past 10 years, OR
• 2 consecutive negative cotests (cytology + HPV) within the past 10 years
• The most recent test must be within the last 5 years 1, 3
• An HPV-negative ASC-US result counts as negative for meeting exit criteria 1

Critical verification requirement: You must confirm adequate screening through medical records review—verbal patient report alone is insufficient. 4

Absolute Contraindications to Stopping Screening at Age 65

Even if a patient reaches age 65, screening must continue in the following circumstances:

History of High-Grade Lesions or Cancer

• Continue screening for 20-25 years after treatment for CIN2, CIN3, adenocarcinoma in situ, or cervical cancer, even if this extends screening well past age 65 years 4, 1, 2
• This extended surveillance reflects the viral etiology of cervical cancer and persistent risk after high-grade disease 1

Inadequate Prior Screening Documentation

• Women who cannot document adequate negative prior screening must continue until cessation criteria are met 4, 1
• Approximately 59.5% of low-income older women lack adequate screening history and require continued testing 5
• Women with limited healthcare access, minority women, and immigrants from countries without screening programs are particularly likely to lack documentation 4

High-Risk Medical Conditions

• HIV-positive individuals require continued screening regardless of age 6, 4, 2
• Immunocompromised patients (solid organ/stem cell transplant recipients, chronic immunosuppressant therapy) require continued screening 4
• In utero diethylstilbestrol exposure requires continued surveillance due to elevated risk of clear cell adenocarcinoma 6, 4

Special Consideration: Hysterectomy Status

Screening should be discontinued in women who have undergone total hysterectomy with cervix removal for benign indications and have no history of CIN2+, CIN3, adenocarcinoma in situ, or cervical cancer. 6, 1, 3

Screening must continue after hysterectomy if: 2

• The hysterectomy was performed for cervical cancer (annual vaginal cytology for 20-25 years post-treatment)
• There is a history of high-grade precancerous lesions

Women with subtotal (supracervical) hysterectomy should continue standard screening recommendations. 1

Clinical Context and Disease Burden

Understanding why age 65 is the stopping point requires recognizing the evidence:

• Among adequately screened women, the 20-year absolute risk of cervical cancer is only 8 per 10,000, compared to 49 per 10,000 in unscreened women—an 84% risk reduction 4
• However, approximately 20% of cervical cancers are diagnosed after age 65, accounting for 25% of all cervical cancer deaths annually 4, 2
• Most cervical cancers in older women occur in those who were never screened or inadequately screened 4, 7
• The proportion of women not recently screened increases with age, from 12.1% at ages 41-45 to 18.4% at ages 61-65 7

Common Pitfalls to Avoid

Do not stop screening at age 65 without verifying adequate prior screening through medical records—this is the most critical error, as 40% of older women continue to receive screening despite guidelines, often due to provider recommendation rather than patient choice. 4, 8

Do not discontinue screening in women with prior CIN2+ until 20-25 years have elapsed since treatment, regardless of current age—this extended period is necessary due to persistent HPV-related risk. 4, 1

Once screening is discontinued after age 65 with adequate prior screening, it should not resume for any reason, including a new sexual partner. 1

Never screen women who had hysterectomy with cervix removal for benign reasons—this provides no benefit and represents unnecessary healthcare utilization. 4, 3