A Pap smear, or Papanicolaou test, screens for precancerous and cancerous changes in the cells of the cervix. This screening is a primary method for the early detection and prevention of cervical cancer, typically caused by persistent infection with the human papillomavirus (HPV). Medical guidelines define specific criteria under which this testing can safely be discontinued. These recommendations are based on age, surgical history, and individual risk profile. Understanding these guidelines prevents unnecessary procedures while ensuring continued protection for those who remain at risk.
Standard Age for Ending Pap Smears
The consensus recommendation is to discontinue routine cervical cancer screening at age 65. This guidance is contingent upon having an “adequate negative screening history” that demonstrates a very low risk of developing new cervical cancer.
This required history means the individual must have had three consecutive negative Pap tests or two consecutive negative co-tests (Pap test combined with an HPV test) within the previous 10 years. The most recent test must have occurred within the last five years, confirming a sustained period of low risk.
The rationale for this age-based cessation is that cervical cancer develops slowly. If a person has consistently screened negative for a decade leading up to age 65, the probability of a new, clinically significant lesion emerging afterward is low. Screening stops because the benefits of early detection diminish, while the potential harms from false positives and unnecessary follow-up procedures increase. If the criteria are not met, testing must continue regardless of age.
Stopping Screening After a Hysterectomy
A distinct circumstance that permits the cessation of cervical cancer screening is the removal of the cervix through a surgical procedure called a hysterectomy. If a person has undergone a total hysterectomy, which involves the complete removal of both the uterus and the cervix, routine Pap smears are generally no longer required. This is because the site where nearly all cervical cancers originate has been removed, eliminating the need for screening.
However, the reason for the surgery is a determining factor in whether screening can stop. The hysterectomy must have been performed for benign reasons, such as fibroids or heavy bleeding, and not for a diagnosis of cervical cancer or high-grade precancerous lesions. If a person had a history of high-grade precancerous cells or cancer, continued screening of the vaginal vault is often necessary to monitor for potential recurrence or new lesions, even after the cervix is removed.
It is also important to distinguish between a total and a supracervical hysterectomy, sometimes called a partial hysterectomy. In a supracervical procedure, the uterus is removed, but the cervix remains intact. Because the cervix is still present, the person remains at risk for cervical cancer and must continue to follow the standard screening schedule.
Conditions That Require Continued Screening
While age 65 and a total hysterectomy for benign reasons are common stopping points, certain medical histories mandate continued screening. A person with a history of high-grade precancerous lesions, specifically cervical intraepithelial neoplasia grade 2 (CIN 2) or grade 3 (CIN 3), must continue screening for at least 25 years following successful treatment, even past age 65. This extended surveillance is necessary because high-grade lesions indicate a higher lifetime risk of developing cancer, making the standard age cutoff unsafe. Similarly, a previous diagnosis of cervical cancer requires continued, specialized follow-up testing determined by the oncology team.
Another exception involves individuals with a compromised immune system, as their bodies are less effective at clearing the HPV infection. For these high-risk groups, the standard age for cessation is disregarded, and more frequent screening may be recommended for life. This includes people who are living with HIV, organ transplant recipients who take immunosuppressant drugs, or those on long-term, high-dose steroid therapy.