The Papanicolaou test, commonly known as the Pap smear, is a screening tool designed to detect precancerous changes and cancer in the cells of the cervix. It has been highly effective in reducing the incidence and mortality rates associated with cervical cancer by identifying cellular abnormalities early. The Pap smear works by collecting a sample of cells from the cervix to examine them under a microscope for signs of dysplasia. Guidelines exist for when this screening can be safely discontinued for individuals who have consistently demonstrated a low risk.
The Standard Cessation Age and Required History
Major medical organizations, including the United States Preventive Services Task Force (USPSTF) and the American College of Obstetricians and Gynecologists (ACOG), recommend that routine cervical cancer screening can stop at age 65 for patients considered to be at average risk. This recommendation is not solely based on reaching a specific birthday but also requires a documented history of adequate negative screening results. The patient must have no history of a moderate or high-grade cervical change, specifically Cervical Intraepithelial Neoplasia grade 2 (CIN 2) or more severe disease, within the past 20 to 25 years.
To meet the criteria for stopping, a patient must have had either three consecutive negative Pap tests alone within the last 10 years, or two consecutive negative co-tests within the last 10 years. A co-test combines the Pap smear with a test for high-risk Human Papillomavirus (HPV). The most recent of these tests must have occurred within the last three to five years before cessation.
This required history provides a high degree of confidence that no undetected, slow-growing lesions exist. The combination of age and a string of normal results confirms the patient is no longer at significant risk for developing new cervical cancer.
Medical Rationale for Stopping Screening
The decision to stop screening at age 65 for average-risk individuals is based on a sound understanding of the natural history of cervical cancer. The vast majority of cervical cancers are caused by persistent infection with high-risk types of the Human Papillomavirus. New high-risk HPV infections are significantly less common in older adults, particularly after menopause.
Furthermore, any existing precancerous lesions in this age group tend to progress extremely slowly, if at all. The prolonged period of required negative screening ensures that any earlier, undetected infection would have likely been cleared by the immune system or would have progressed slowly enough to be detected during routine testing. The risk of a new, rapidly developing cancer after a long history of negative results is therefore very low.
Continuing to screen a low-risk older population may lead to potential harms, such as false-positive results due to cellular changes related to menopause, which can then lead to unnecessary follow-up procedures. The balance of benefits versus harms shifts in this age group, making continued screening unwarranted for those who meet the “adequate prior screening” criteria.
Exceptions: When Screening Must Continue
There are important exceptions where screening must continue well past the standard age of 65. Patients with a history of a high-grade precancerous lesion, specifically CIN 2, CIN 3, or adenocarcinoma in situ (AIS), must continue screening for at least 20 years after the initial diagnosis and appropriate management. This continuation applies even if it extends the screening period past age 65.
Patients with a compromised immune system also require continued, and often more frequent, screening. This high-risk group includes individuals who are HIV-positive or those who have received an organ transplant. The immune system’s reduced ability to clear HPV infections means the risk of developing cervical cancer remains elevated regardless of age.
Another exception is for women whose mothers were exposed to Diethylstilbestrol (DES) while pregnant, as this exposure increases the risk for a rare type of cervical and vaginal cancer. Lastly, individuals who have not had a documented history of adequate prior screening should continue to be screened until the requirements are fulfilled.
Post-Cessation Monitoring and General Gynecological Health
Stopping routine Pap or HPV screening does not mean an end to all gynecological care. General health monitoring, including annual check-ups, remains a component of preventative care. While the need for a Pap smear ceases, some providers may still recommend a general pelvic examination as part of the overall assessment of reproductive health.
The focus of ongoing care shifts to symptom awareness. Patients should immediately report any unusual symptoms, such as unexpected vaginal bleeding, pelvic pain, or abnormal discharge, to their healthcare provider. These symptoms warrant an evaluation regardless of prior screening history or age, as they can indicate various gynecological or general health issues.