How Often Should a 70 Year Old Have a Pap Smear?

Oct 4, 2025 4 min read •

women's health Senior Health Cancer Prevention

For many low-risk women, cervical cancer screening guidelines recommend stopping Pap tests after age 65. This brings into focus the crucial question: How often should a 70 year old have a Pap smear? The answer is not universal and depends on a woman's health history and risk factors, underscoring the importance of informed discussion with a healthcare provider.

Quick Summary

Most low-risk women with a history of regular, normal Pap tests can safely stop cervical cancer screening by age 70, but continued screening is necessary for those with a history of abnormal results or other risk factors.

Key Points

Screening can often be discontinued: For most women aged 65-70 who have a history of adequate and consistently negative screening results, Pap tests can be stopped.
Consult a doctor: The decision to stop screening must be made with a healthcare provider who can review your specific medical history and risk profile.
High-risk factors require continued screening: A history of abnormal Pap results, a weakened immune system, or exposure to DES are all reasons to continue regular cervical cancer screening past age 70.
Hysterectomy impacts screening needs: Women who have had a total hysterectomy (removal of the uterus and cervix) for benign reasons typically do not need Pap smears, but those with a supracervical hysterectomy still require screening.
Other gynecological care remains important: Even if Pap tests are no longer necessary, regular gynecological check-ups should continue to monitor other aspects of senior women's health.
Adequate screening history is key: The standard for stopping includes having three consecutive negative Pap tests or two consecutive negative co-tests (Pap and HPV) in the last 10 years.

Understanding the Guidelines for Women Over 65

For many years, the standard for Pap smears was an annual screening. However, as medical understanding of cervical cancer and its progression has evolved, guidelines have been updated to reflect more nuanced, evidence-based approaches. Cervical cancer develops slowly and is primarily caused by persistent infection with high-risk human papillomavirus (HPV). Because of this, for women over 65 who have a consistent history of negative screening results, the risk of developing cervical cancer is very low.

Major health organizations, including the American Cancer Society (ACS), the American College of Obstetricians and Gynecologists (ACOG), and the U.S. Preventive Services Task Force (USPSTF), have all established guidelines regarding the discontinuation of cervical cancer screening in older adults. These recommendations are based on years of research and a detailed assessment of the benefits and harms of continued screening in this age group.

Criteria for Discontinuing Screening at Age 70

According to several guidelines, a 70-year-old woman can stop having Pap smears if she meets specific low-risk criteria. These criteria generally include:

Adequate Negative Screening History: The woman must have a documented history of several recent negative tests. Specifically, this is often defined as three consecutive negative Pap tests or two consecutive negative co-tests (a Pap test and an HPV test combined) within the past 10 years.
No History of High-Grade Precancerous Lesions: The individual should have no history of high-grade cervical intraepithelial neoplasia (CIN2 or CIN3) or cervical cancer within the last 25 years.
No High-Risk Factors: Certain risk factors necessitate continued screening, which will be discussed in detail below.

It is vital that the decision to stop screening is made in consultation with a healthcare provider who can review a woman's complete medical history. A provider will confirm that the screening history is adequate and that no high-risk factors are present.

When is Continued Screening Past 70 Recommended?

While many women can stop screening, others should continue to receive regular Pap tests or other forms of cervical cancer screening. The following are key reasons why a 70-year-old may need to continue testing:

History of Abnormal Results: If a woman has a history of high-grade abnormal Pap tests or cervical cancer within the last 20-25 years, continued screening is required.
Weakened Immune System: Women with compromised immune systems due to conditions like HIV infection, an organ transplant, or long-term steroid use have a higher risk of developing cervical cancer and should continue screening.
DES Exposure: Women who were exposed to diethylstilbestrol (DES) in utero have a higher lifetime risk of vaginal and cervical clear-cell adenocarcinoma and require ongoing surveillance.
Hysterectomy with Cervix Intact: If a woman has had a hysterectomy but still has her cervix (supracervical hysterectomy), she still needs regular Pap tests based on age and previous screening history.
New Sexual Partner: According to some guidelines, a new sexual partner after age 65 can be considered a risk factor that warrants continued screening due to the potential for new HPV exposure.

The Role of HPV Testing in Older Women

Human papillomavirus (HPV) testing plays a significant role in modern cervical cancer screening. For women aged 30-65, co-testing (Pap and HPV) every five years is a common screening option. For older women, especially those nearing the discontinuation cutoff, the HPV test can provide valuable information. An HPV test can detect the presence of high-risk HPV types, which are responsible for almost all cases of cervical cancer. A consistently negative HPV test history, along with negative Pap tests, can provide greater assurance for safely discontinuing screening.

Risks and Benefits of Continuing Pap Tests Past Age 70

The decision to continue or stop screening should weigh the potential benefits against the risks. While Pap tests are generally safe, continued screening in a low-risk older woman can carry certain disadvantages.


Aspect	Benefit of Continuing Pap Tests	Harm of Continuing Pap Tests
Screening Accuracy	Detects a small number of potential lesions in high-risk populations.	Less accurate in post-menopausal women due to cervical atrophy, potentially leading to more false positives and unnecessary follow-ups.
Anxiety & Discomfort	Peace of mind for high-risk individuals.	Can cause anxiety and physical discomfort, especially for women with vaginal dryness or atrophy.
Procedural Risk	Can lead to detection of a treatable condition.	Risk of invasive follow-up procedures (e.g., colposcopy, biopsy) resulting from false positives, which can increase with age.
Cost & Effort	Ensures high-risk individuals receive necessary care.	Higher healthcare costs and time commitment for minimal benefit in low-risk women.

The Final Word: Shared Decision-Making

The most important step for any woman turning 70 is to have a thorough discussion with her gynecologist or primary care physician. Together, you can review your complete medical history, including your screening records and risk factors, to determine the most appropriate course of action. This is called shared decision-making and ensures that your healthcare plan aligns with your individual needs and preferences.

Regular gynecological visits should continue even if Pap smears are no longer needed. These appointments are crucial for discussing other aspects of women's health in older age, such as menopause symptoms, bone density, and overall preventive care. For more detailed information on screening guidelines, you can consult resources like the American Cancer Society's official guidelines for cervical cancer screening: https://www.cancer.org/cancer/types/cervical-cancer/detection-diagnosis-staging/cervical-cancer-screening-guidelines.html.

In conclusion, while many 70-year-olds can safely stop routine Pap smears, this is a decision that must be made carefully, based on a comprehensive review of personal health history and in consultation with a trusted healthcare provider. Prioritizing overall health and having open communication with your doctor remains essential for healthy aging.

Frequently Asked Questions

It depends on the type of hysterectomy and the reason for it. If you had a total hysterectomy where the cervix was also removed for a benign condition, you typically do not need further Pap smears. However, if the hysterectomy was for cervical cancer or high-grade precancerous cells, or if the cervix was not removed, you should continue screening.

Adequate prior screening usually means you have had three consecutive normal Pap tests or two consecutive normal co-tests (Pap and HPV) within the last 10 years. Your healthcare provider will confirm this based on your medical records.

Yes, for low-risk women, the potential harms of continued screening may outweigh the minimal benefits. Risks can include a higher rate of false-positive results due to cervical changes, leading to unnecessary and potentially invasive follow-up procedures, as well as anxiety and discomfort.

Some guidelines suggest that a new sexual partner after age 65 can be a risk factor for new HPV exposure. If this applies to you, it's an important factor to discuss with your healthcare provider when making a decision about continued screening.

If your screening history is uncertain or incomplete, your doctor may recommend a repeat Pap test or co-testing to establish a clear baseline. This is often the safest course of action to ensure adequate screening has been achieved before stopping.

No, for women over 65, the HPV test alone is not a replacement for a Pap smear, but it is often used in combination (co-testing) for screening in women under 65. If you are near the age cutoff for stopping, your doctor might use your HPV test history as part of the assessment for discontinuing all screening.

Yes, women with a compromised immune system should continue screening past the standard age cutoff. This is because their risk of developing cervical cancer is higher, and the protective effect of past negative tests is less reliable.

References

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.