Why do they stop giving Pap smears after 65? Understanding the Current Guidelines

Oct 4, 2025 4 min read •

senior care women's health Healthy Aging

Recent data from major health organizations suggests that for women with a history of normal screenings, the risk of cervical cancer significantly decreases with age. This is the primary reason why they stop giving Pap smears after 65, based on updated medical guidelines and a personalized risk-based approach to care.

Quick Summary

Routine Pap smears are typically discontinued after age 65 for women with a history of adequate and normal test results because the risk of cervical cancer in this group becomes very low.

Key Points

Reduced Risk: For women with consistent negative screening history, the risk of developing cervical cancer is very low after age 65.
Adequate History is Key: The decision is based on specific criteria, typically a history of multiple consecutive negative Pap or HPV tests over the past decade.
Post-Menopausal Changes: Physiological changes following menopause contribute to a lower incidence of new HPV infections leading to cancer.
Not a Universal Rule: Women with a history of cervical abnormalities, compromised immunity, or incomplete hysterectomy may still require screening.
Informed Discussion: The decision to stop screening should always be a collaborative process between a patient and their healthcare provider.
Pelvic Exams Still Necessary: Discontinuing Pap tests does not eliminate the need for general pelvic exams for broader women's health monitoring.

The Rationale Behind Stopping Routine Screening

For many women, the annual or routine Pap smear is a lifelong medical procedure. So, the question of why they stop giving Pap smears after 65 is a common and important one. The shift in screening recommendations is not arbitrary but is based on extensive research and a better understanding of how cervical cancer develops. Medical and public health bodies, such as the American Cancer Society (ACS) and the U.S. Preventive Services Task Force (USPSTF), have updated their guidelines over time to reflect this evolving evidence.

The Lifecycle of Cervical Cancer and the Role of HPV

Cervical cancer is most often caused by a persistent infection with the human papillomavirus (HPV). The virus is very common, but in most cases, the body's immune system clears the infection on its own. It's the long-term, persistent infection with high-risk HPV strains that can lead to abnormal cell changes (dysplasia) and, eventually, cancer. The development of cervical cancer is a slow process, often taking 10 to 20 years or more to progress from a persistent infection to a detectable tumor.

By age 65, most women have either been exposed to and cleared HPV infections or have not had a persistent, high-risk infection. For those with a consistent history of normal Pap or HPV test results, the chances of a new infection leading to cancer are extremely low. This is the central logic behind the updated guidelines.

Key Criteria for Discontinuing Pap Smears

According to current recommendations, the decision to stop cervical cancer screening at age 65 is based on two main criteria:

Adequate Negative Screening History: The woman must have a history of adequate screening with either three consecutive negative Pap tests or two consecutive negative HPV co-tests (Pap and HPV test) within the previous 10 years.
No High-Risk Factors: The woman must not have any risk factors for cervical cancer, such as a history of moderate to severe cervical dysplasia (CIN2 or CIN3), adenocarcinoma in situ (AIS), or cervical cancer. Women with a compromised immune system (e.g., due to an organ transplant, HIV, or long-term steroid use) may also need to continue screening.

It is crucial to note that these are general guidelines, and the final decision should always be a personal one made in consultation with a healthcare provider who can review a patient's complete medical history.

Comparison of Screening Guidelines Over Time

Screening protocols have evolved significantly as our understanding of cervical cancer has improved. The move from routine annual Pap tests to a less frequent, risk-based schedule is a testament to this progress.


Feature	Historical Approach (Pre-2000s)	Modern Approach (Current Guidelines)
Frequency	Annual Pap smears from age 18 or first sexual activity.	Starts at age 21. Less frequent screening (every 3-5 years) for women with normal results.
Screening Endpoint	Often continued indefinitely, or until a hysterectomy.	Typically stops at age 65 for women meeting specific criteria.
Technology	Pap smear was the primary tool.	Combined Pap and HPV testing (co-testing) is preferred for better sensitivity.
Focus	Primarily focused on cytology (cell changes).	Shifted to include testing for the underlying cause (high-risk HPV).

Considerations for Continued Screening

Not every woman over 65 will be able to stop routine screening. There are important exceptions to the general rule. Screening may continue for those with:

A history of high-grade precancerous lesions (CIN2, CIN3).
A history of cervical cancer.
A suppressed immune system due to medical conditions or medications.
Exposure to DES (diethylstilbestrol) in utero.
For women who have had a hysterectomy, if it was a supracervical hysterectomy (leaving the cervix intact), they will still need regular screenings. Screening is generally not needed after a total hysterectomy (removal of the cervix) for non-cancer reasons, provided there is no history of high-grade abnormalities.

The Importance of Pelvic Exams

It is also important to differentiate between a Pap test and a general pelvic exam. The Pap test specifically screens for cervical cancer. Stopping routine Pap tests does not mean that regular pelvic health check-ups should cease. A pelvic exam is a broader assessment of a woman's reproductive organs and overall pelvic health. These exams can still be a valuable part of an annual check-up to monitor for other issues, such as ovarian cysts, uterine fibroids, and other conditions that can affect post-menopausal women.

Making an Informed, Personalized Decision

Your healthcare provider is the best person to discuss your individual health history and risk factors. They can confirm whether you have met the criteria to safely discontinue Pap smears. It's also an opportunity to discuss any gynecological concerns you may have, ensuring you continue to receive comprehensive care as you age. For comprehensive information on cancer screening, visit the American Cancer Society. This ongoing dialogue ensures that your healthcare decisions are tailored to your specific needs and medical history, providing the best possible protection while avoiding unnecessary procedures.

Conclusion: Prioritizing Risk-Based Care

In conclusion, the practice of stopping Pap smears after 65 is a well-founded medical decision based on a woman's adequate negative screening history and a significantly reduced risk of cervical cancer development. This move reflects a broader trend in medicine toward personalized, risk-based care that minimizes unnecessary procedures while maintaining high standards of preventive health. By understanding the underlying reasons and discussing your unique situation with a healthcare professional, you can confidently navigate your healthcare journey into your senior years.

Frequently Asked Questions

For most women with a history of adequate and normal screenings, it is safe to stop, as the risk of cervical cancer significantly decreases with age. This is based on guidelines from major medical organizations.

If you have a history of moderate to high-grade cervical dysplasia (precancerous changes), you should continue screening for at least 20 years after the abnormality was treated, regardless of your age.

Yes. Current guidelines often combine Pap and HPV testing (co-testing). Having two consecutive negative co-tests in the past 10 years is often a criterion for stopping screening at age 65.

If your hysterectomy removed your cervix and was performed for a non-cancerous reason, you generally no longer need Pap tests. However, if the cervix was left intact (supracervical hysterectomy), you may still require screening.

While rare in women who have been consistently screened, cervical cancer can occur after age 65, particularly in those who did not receive adequate screening in their younger years. This underscores the importance of a complete medical history.

Continuing unnecessary screening can lead to higher rates of false-positive results, which may cause patient anxiety and potentially lead to more invasive and costly follow-up procedures.

Yes, general pelvic exams are still an important part of routine wellness checks to assess other aspects of pelvic health, such as the uterus, ovaries, and vagina, even after Pap tests are discontinued.

For more information, you can consult authoritative sources like the American Cancer Society, the Centers for Disease Control and Prevention (CDC), or the U.S. Preventive Services Task Force (USPSTF).

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.