Understanding the Guidelines: Age 65 and Beyond
Cervical cancer screening, including Pap smears, can often be discontinued for many women after age 65. The United States Preventive Services Task Force (USPSTF) advises against screening women over 65 who have had adequate prior normal results and are not high risk. Adequate prior screening is typically defined as three consecutive negative Pap tests or two consecutive negative HPV tests within the last decade, with the most recent test within the past 3-5 years.
Why Screening Frequency Changes with Age
Persistent human papillomavirus (HPV) infection is the primary cause of cervical cancer. Most women over 65 have cleared past HPV infections, and new infections are less common. Cervical cancer develops slowly, often over decades. Women with a history of normal screenings have a very low risk after 65.
Exceptions to the Rule: When to Continue Screening
Some risk factors require continued screening past age 65, making discussion with a healthcare provider vital. Exceptions include a history of high-grade precancerous lesions, requiring screening for at least 20-25 years post-finding, a compromised immune system, in-utero DES exposure, inadequate prior screening, or recent concerns about cases in women over 65.
Comparing Screening Options: Pap Smear vs. HPV Testing
Older women needing continued screening might use a Pap test, HPV test, or both. Here's a brief comparison:
| Screening Method | Looks For | Frequency (age 30-65) | Effectiveness in Older Women | Potential Harms |
|---|---|---|---|---|
| Pap Test | Abnormal cervical cells | Every 3 years | Decreased effectiveness due to tissue changes | Less sensitive than HPV test; discomfort |
| HPV Test | Presence of high-risk HPV types | Every 5 years | More sensitive, offering longer reassurance | Potential for anxiety from transient infections; historically less available |
| Co-testing (Pap + HPV) | Abnormal cells and high-risk HPV | Every 5 years | Higher detection rate than Pap alone | Can lead to over-screening and anxiety; higher cost |
The Annual Gynecological Exam
Even without a Pap smear, regular pelvic exams and wellness checks remain important for detecting other issues in older women, such as ovarian cancer or pelvic organ prolapse.
Communicating with Your Healthcare Provider
Deciding to stop cervical cancer screening is a personal choice based on a detailed medical history review. Discussing screening history and risk factors with a provider is essential. More information can be found at {Link: healthcity.bmc.org https://healthcity.bmc.org/inadequate-cervical-cancer-screening-puts-women-65-risk/}.
Conclusion
Determining how often should a 74 year old woman get a pap smear relies on individual history. While many over 65 can stop screening with normal results and no high risk, specific factors may necessitate continued testing. An annual visit allows review of risk factors and discussion of other health assessments. {Link: USPSTF website https://www.uspreventiveservicestaskforce.org/} is a good resource for preventive health measures.
