The recommendations for cervical cancer screening have evolved over time. While Pap smears were once a routine part of women's health for all ages, current guidelines recognize that for many older women with a history of negative screenings, the risk of developing cervical cancer significantly decreases.
The Rationale for Stopping Routine Screening After 65
The decision to stop routine cervical cancer screening around age 65 for women with a consistently normal screening history is based on several factors:
- Long-term Screening History: Cervical cancer typically develops slowly from persistent high-risk HPV infection. A history of many years of normal screening indicates a low likelihood of developing cancer.
- Reduced Effectiveness of Pap Tests: Hormonal changes in postmenopausal women can make Pap tests less accurate, potentially leading to false-positive results and unnecessary procedures.
- Lower Risk of New HPV Infection: While not impossible, the rate of new high-risk HPV infections leading to cervical cancer is lower in older women.
Guidelines from Major Health Organizations
Major health organizations, such as the U.S. Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS), provide similar guidelines regarding when women of average risk can stop screening. Generally, this is around age 65 if certain criteria for adequate prior screening are met.
Adequate prior screening is typically defined as having one of the following within the past 10 years, with the most recent test within the last 5 years:
- Three consecutive negative cytology (Pap) tests.
- Two consecutive negative co-tests (Pap and HPV tests).
- Two consecutive negative primary high-risk HPV tests.
When to Continue Screening Past 65
There are specific situations where a 70-year-old woman should continue cervical cancer screening, even if she has passed the typical age cutoff. These include:
- History of High-Grade Lesions or Cancer: Screening should continue for at least 25 years after treatment for CIN 2 or 3 or cervical cancer.
- Compromised Immune System: Women with weakened immune systems due to conditions like HIV, organ transplant, or long-term steroid use are at higher risk and require continued screening as recommended by their doctor.
- Inadequate Prior Screening: If a woman's screening history is incomplete or she has not had regular screenings, she should continue until the criteria for stopping are met.
- Exposure to DES: Women exposed to diethylstilbestrol (DES) before birth have an increased risk of a rare cervical cancer and need ongoing monitoring.
Comparison of Screening Scenarios for a 70-Year-Old
| Screening Scenario | Criteria | Recommendation for 70-Year-Old |
|---|---|---|
| Low-Risk | Adequate prior screening (e.g., 3 negative Pap tests or 2 negative co-tests in the last 10 years), no history of high-grade lesions, no compromised immune system. | Can safely discontinue routine screening. Must continue other regular checkups. |
| High-Risk (Due to History) | Documented history of a high-grade lesion (CIN2 or higher) or cervical cancer. | Must continue screening for 25 years after diagnosis/treatment, regardless of age. |
| High-Risk (Due to Health Status) | Compromised immune system (e.g., HIV, transplant recipient) or a history of DES exposure. | Must continue screening on a schedule determined by your healthcare provider. |
| Inadequate History | Screening history is unknown, poorly documented, or incomplete prior to age 65. | Should continue screening until adequate negative tests are documented. |
The Importance of an Ongoing Dialogue with Your Doctor
The decision to stop or continue screening is highly personal and requires a discussion with a healthcare provider who can review your full medical history and risk factors. While Pap smears may not be necessary for everyone, other important health screenings and gynecological care should continue. A pelvic exam, often part of an annual checkup, is different from a Pap smear and helps detect other conditions. This ongoing communication ensures appropriate care throughout life.
Conclusion
For many 70-year-old women with a history of adequate normal screenings, routine Pap smears are no longer needed. However, continued screening is necessary for those with specific risk factors such as a history of high-grade lesions, a compromised immune system, or an inadequate screening history. Cervical cancer cases still occur in women over 65, emphasizing the need for personalized risk assessment. Ultimately, a healthcare provider should make the decision in consultation with the patient, balancing the benefits of screening with potential risks of unnecessary procedures. For additional information, the National Cancer Institute is a valuable resource(https://www.cancer.gov/news-events/cancer-currents-blog/2023/catch-up-hpv-testing-older-women).
