A Pap smear, formally known as a Papanicolaou test, is a screening procedure designed to detect abnormal cells on the cervix. The cervix is the lower, narrow part of the uterus that connects to the vagina. Its purpose is to identify potentially precancerous or cancerous changes early, allowing for timely intervention and prevention of cervical cancer.
This test involves collecting cells from the cervix, typically during a routine pelvic exam, which are then examined under a microscope. By detecting these cellular changes early, Pap smears play a significant role in reducing the incidence and mortality rates associated with cervical cancer. This test finds abnormal cells before they become cancerous, or at a very early, treatable stage.
General Age for Stopping
Healthcare providers commonly suggest discontinuing routine Pap smears around age 65. This guideline is supported by 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). These recommendations are based on research indicating that the risk of developing new cervical abnormalities decreases in older age, provided there has been a consistent history of normal screening results.
For individuals aged 25 to 65, current guidelines often recommend primary HPV testing every five years, with co-testing (HPV and Pap test together) or Pap tests alone as alternatives. This shift reflects that nearly all cervical cancers are caused by persistent HPV infections.
Criteria for Discontinuation
Reaching age 65 is not the sole factor for discontinuing Pap smear screening; specific medical history criteria must also be met to safely stop. Individuals should have a documented history of adequate prior screening, typically three consecutive negative Pap tests or two consecutive negative co-tests (Pap and HPV tests) within the last 10 years, with the most recent test within the past five years.
Additionally, there should be no history of moderate or severe cervical dysplasia (CIN2/3) or cervical cancer. CIN2/3 refers to abnormal cell changes affecting a significant portion of the cervical surface, indicating a higher grade of abnormality. These are considered high-grade lesions that carry a higher risk of progression to cancer. Individuals who have undergone a total hysterectomy for benign conditions generally no longer require cervical cancer screening.
When Screening Should Continue
Even if general age guidelines are met, certain circumstances and risk factors necessitate continued Pap smear screening beyond age 65. Individuals with a history of moderate or severe cervical dysplasia (CIN2/3) or cervical cancer should continue screening for at least 20 to 25 years following their diagnosis or treatment, even if this extends past age 65. These conditions indicate a higher, ongoing risk of developing cervical cancer.
Individuals who were exposed to diethylstilbestrol (DES) in utero also need to continue screening indefinitely, as they have an increased risk for a rare type of cervical and vaginal cancer. Those with a compromised immune system, such as individuals with HIV, organ transplant recipients, or on certain immunosuppressive medications, should continue screening. Their weakened immune response makes them less likely to clear HPV infections, increasing their susceptibility to cervical cancer.