HPV Co-Testing for a 61-Year-Old Woman
Yes, you can perform HPV co-testing for a 61-year-old woman with an intact cervix, and in fact it is recommended if she has not met adequate screening exit criteria. 1
Current Screening Recommendations for Ages 30-65
For women aged 30-65 years, three equally acceptable screening strategies exist: 1
- Primary HPV testing every 5 years (preferred by the American Cancer Society) 1
- Co-testing (HPV + cytology) every 5 years (preferred by ACOG and NCCN) 1, 2
- Cytology alone every 3 years (acceptable but less preferred) 1, 2
At age 61, this patient remains within the standard screening window and should continue routine screening unless she has already met exit criteria. 1
Critical Exit Criteria That Must Be Met to Stop Screening
To discontinue screening at age 65, all of the following must be documented: 1
- Either 3 consecutive negative cytology tests or 2 consecutive negative co-tests within the past 10 years 1
- The most recent test performed within the last 5 years 1
- No history of CIN 2, CIN 3, adenocarcinoma in situ, or cervical cancer in the preceding 25 years 1
Updated 2026 Exit Requirements
The American Cancer Society now requires negative primary HPV tests (preferred) or negative co-tests at both ages 60 and 65 years as a prerequisite for exiting screening, with the last test performed at age ≥ 65. 3 This change was made in response to high rates of cervical cancer among individuals older than 65 years and poor implementation of previous exit criteria. 3
Why Co-Testing Remains Valuable at This Age
- Co-testing provides the highest sensitivity among all screening modalities for detecting CIN 2+ and cervical cancer 1, 2
- After a negative co-test, the 5-year cumulative risk of CIN 2+ is only 0.27-0.34%, the lowest risk of any screening strategy 1, 4
- Co-testing improves detection of adenocarcinoma precursors, which account for approximately 20% of cervical cancers 1
Common Pitfalls to Avoid
- Never discontinue screening without verifying adequate prior negative screening history through medical records review—verbal patient report is insufficient 1
- Do not stop screening at age 65 if the patient has inadequate prior screening documentation, even if she reports being "up to date" 2
- Do not assume a patient can exit screening simply because she is approaching age 65; she must have documented negative tests at the correct intervals 1, 3
Special Populations Requiring Continued Screening Beyond Age 65
Continue screening indefinitely (or for 20-25 years after treatment) if the patient has: 1, 2
- History of CIN 2, CIN 3, or adenocarcinoma in situ 1
- History of cervical cancer 1
- HIV infection or immunosuppression (organ transplant, chronic corticosteroids, chemotherapy) 1
- In-utero DES exposure 1
Practical Recommendation for This 61-Year-Old
Order co-testing (HPV + cytology) now if she has not had adequate recent screening. 1 If both tests are negative, repeat co-testing at age 65 to fulfill the updated 2026 exit criteria requiring negative tests at both ages 60 and 65. 3 This approach ensures she meets the stringent requirements for safely discontinuing screening after age 65 while providing maximal protection against cervical cancer during this critical transition period.