When Can a Woman Stop Cervical Cancer Screening?
According to major health organizations, women over the age of 65 generally no longer require routine Pap smear testing for cervical cancer. This is because the risk of developing cervical cancer decreases significantly with age for women with a history of consistent, normal test results.
Criteria for Discontinuing Screening
To be eligible to stop screening, a woman typically needs a history of adequate prior screening, which includes either three consecutive negative Pap tests or two consecutive negative HPV or co-tests within the last 10 years, with the most recent test within the last 3-5 years. These criteria apply to women with no history of moderate to high-grade abnormal cervical cells or cervical cancer.
Special Circumstances Requiring Continued Screening
Certain factors may necessitate continued Pap testing beyond age 65 or 70. These include a history of serious cervical pre-cancer (like CIN2 or CIN3) within the last 20 years, a weakened immune system, or exposure to diethylstilbestrol (DES) in the womb. Women who have not had regular cervical cancer testing may also need to continue screening.
Pap Smear vs. Annual Gynecological Exam
It is important to remember that a Pap smear is a specific test for cervical cancer and is not the same as an annual gynecological exam. Even if Pap testing is discontinued, routine gynecological checkups are still recommended for overall health, addressing concerns like menopause symptoms, pelvic pain, and breast health. A pelvic exam, which is part of a comprehensive gynecological visit, may still be performed even without a Pap smear.
Comparative Guidelines: Major Health Organizations
Major health organizations have consistent recommendations regarding discontinuing screening after age 65 for low-risk women. The table below outlines some of these guidelines.
| Organization | Recommendation for Women > 65 | Nuances and Exceptions |
|---|---|---|
| American College of Obstetricians and Gynecologists (ACOG) | Screening can stop if criteria are met. | Recommends yearly pelvic exams. Continued screening needed for those with risk factors. |
| U.S. Preventive Services Task Force (USPSTF) | Recommends against screening for women over 65 with adequate prior screening and no high risk. | Defines adequate screening as per specific test history criteria. |
| American Cancer Society (ACS) | Recommends stopping screening at age 65 for women with adequate prior negative screening and no history of high-grade pre-cancer. | Emphasizes continuing screening for those with a history of serious pre-cancer for at least 25 years. |
| Medicare | Covers Pap smears every 24 months for most beneficiaries, every 12 months for higher risk. | Coverage allows for continued testing, but medical necessity should guide the decision. |
Conclusion
For a 70 year old woman, routine Pap smear screening is typically not necessary if she has a history of normal test results and no high-risk factors. This aligns with current guidelines from major health organizations. However, it is crucial to discuss your specific medical history with a healthcare provider to determine the most appropriate screening plan for you. While Pap smears may cease, annual gynecological exams remain important for addressing other aspects of women's health as they age. For more information, you can visit the Office on Women's Health.
