Cervical Cancer Screening Recommendation for a 66-Year-Old Woman
No cervical cancer screening is recommended for this 66-year-old woman, and screening should not be resumed despite her new sexual partner. 1
Primary Recommendation
The American Cancer Society explicitly states that once screening is discontinued after age 65, it should not resume for any reason, even if an individual reports a new sexual partner. 1 This represents the most definitive guidance from the highest-quality, most recent (2020) cervical cancer screening guidelines. 1
Rationale for Not Resuming Screening
Adequate Prior Screening History
- This patient meets cessation criteria with a negative test at age 63, which falls within the required timeframe (most recent test within the past 5 years before age 65). 1
- She has "always had previous testing," suggesting adequate prior screening history. 1
Evidence Against New Partner Risk
The 2020 ACS guideline directly addresses concerns about new sexual partners in older women: 1
- Available evidence suggests that few persons aged >65 years are likely to develop new infections that will follow a life-threatening course. 1
- Modeling studies demonstrate low absolute risk even when assuming double the current HPV prevalence in older women. 1
- The 20-year absolute risk of cervical cancer in regularly screened women aged 50-64 was only 8 per 10,000, compared to 49 per 10,000 in unscreened women. 1
Natural History Considerations
- Based on the extended natural history of cervical disease, it is improbable that incident HPV infections and newly detected CIN3 after age 65 will have sufficient time to progress to invasive cancer in the woman's lifetime. 1
- While HPV reactivation and new infections are theoretically possible, these concerns have been studied and do not justify resuming screening. 1
Critical Exceptions That Do NOT Apply Here
Screening would only continue beyond age 65 if: 1, 2
- History of CIN2, CIN3, or adenocarcinoma in situ (requires 20 years of continued screening) 1, 2
- Immunocompromised status (HIV, organ transplant, chronic corticosteroids, chemotherapy) 1, 2
- History of cervical cancer or in utero DES exposure 1, 2
- Inadequate prior screening documentation 2
None of these exceptions are mentioned in this patient's history. 1
Common Pitfall to Avoid
Do not be swayed by the "new sexual partner" information. This is explicitly addressed in guidelines as NOT being a reason to resume screening. 1 The guideline development group specifically considered the theoretical increased risk from new partners in the current generation of older women and concluded the evidence does not support screening resumption. 1
Practical Challenges in Older Women
Even if screening were considered, technical limitations reduce its effectiveness: 1
- The transformation zone is not visible during colposcopy in approximately two-thirds of women aged 60-89. 1
- Anatomic changes, vaginal atrophy, and musculoskeletal disorders make adequate sampling difficult and examinations painful. 1
- Screening efficacy is diminished with increasing age due to these factors. 1
Strength of Evidence
This recommendation is based on: 1
- Consensus across major guidelines (ACS 2012 and 2020, USPSTF, ACOG) 1, 2
- Large observational cohort studies showing very low cancer risk after adequate screening 1
- Modeling studies demonstrating minimal benefit and poor cost-effectiveness of continued screening 1
- Direct evidence addressing the specific concern about new sexual partners 1