From the Guidelines
The recommended age to stop Pap smear screening is 65 years for women with adequate prior negative screening and no history of moderate or severe cervical dysplasia or cancer. According to the American Cancer Society guidelines, as stated in the study published in 2019 1, women aged >65 y who have had ≥3 consecutive negative Pap tests or ≥2 consecutive negative HPV and Pap tests within the last 10 y, with the most recent test occurring in the last 5 y, should stop cervical cancer screening. This guideline is based on the fact that the risk of developing cervical cancer decreases significantly after 65 in women with adequate prior screening, while the potential harms from continued screening (anxiety, unnecessary procedures) increase. Key points to consider include:
- Adequate prior screening means three consecutive negative Pap tests or two consecutive negative HPV/Pap co-tests within the previous 10 years, with the most recent test occurring within the past 5 years.
- Women should continue screening beyond age 65 if they have a history of cervical cancer, HIV infection, immunosuppression, or were exposed to DES in utero.
- Women who have had a total hysterectomy (removal of the cervix) for non-cancerous reasons can discontinue screening, as stated in the guidelines 1.
- Cervical cancer develops slowly, so women with consistently negative results by age 65 have very low risk of developing the disease later in life. The guidelines emphasize the importance of informed decision-making and consideration of individual patient factors, such as life expectancy and health status, when determining the appropriate age to stop screening 1.
From the Research
Age Cutoff for Pap Smear
- The age cutoff for Pap smear screening varies according to different guidelines and studies.
- A study published in 2017 2 recommends cytology screening (Pap test) every 3 years for women aged 21-65.
- Another study published in 2021 3 suggests that HPV-based primary screening from 25 years could improve outcomes, as South African women have high rates of HIV, Pap smear abnormalities, and HR-HPV, with low cervical cancer screening coverage.
- However, there is no specific age cutoff mentioned in the other studies 4, 5, 6, which focus on awareness, perceived risk, and practices related to cervical cancer and Pap smear screening among HIV-positive women, comparison of cervical cancer screening methods, and primary HPV and molecular cervical cancer screening in US women living with HIV.
Screening Guidelines
- The study published in 2017 2 also mentions that women aged 30 to 65 have the option of adding the HPV test (co-test) every 5 years.
- The study published in 2021 6 compares the sensitivity, specificity, and positive predictive value of different screening methods, including primary HPV screening, co-testing, and p16/Ki-67 immunocytochemistry, but does not provide a specific age cutoff for Pap smear screening.
Demographic Variables
- The study published in 2017 2 found that recent immigrants to the United States, women without insurance, and women without a usual source of healthcare had lower odds of being up to date with screening.
- The study published in 2021 3 found that older women (30+ years) had higher rates of abnormal Pap smears and HR-HPV infection compared to younger women (18-29 years).