A Pap smear, also known as a Papanicolaou test, is a screening method for cervical cancer. It involves collecting cervical cells to detect abnormalities early, helping prevent cancer.
Current Pap Smear Guidelines for Women Over 65
For many women, routine Pap smear screening can discontinue after age 65. Major health organizations, including the American Cancer Society and the U.S. Preventive Services Task Force, recommend stopping if specific criteria are met.
Adequate prior screening is defined as three consecutive negative Pap tests or two consecutive negative co-tests (Pap test combined with Human Papillomavirus, or HPV, test) within the last 10 years. The most recent test should have occurred within the past three to five years. If a woman has consistently met these conditions and has no history of cervical intraepithelial neoplasia (CIN) grade 2 or 3, or adenocarcinoma in situ, routine screening is no longer necessary. Once screening is stopped based on these guidelines, it’s not recommended to restart for average-risk women.
Situations Requiring Continued Screening
Despite general recommendations for discontinuing Pap smears after age 65, certain circumstances necessitate continued screening for older women. Women with a history of high-grade precancerous lesions, such as CIN2 or CIN3, or cervical cancer, should continue screening for at least 20 to 25 years after their diagnosis or treatment, even if this extends beyond age 65.
A situation involves women whose mothers were exposed to diethylstilbestrol (DES) in utero. DES-exposed individuals have a higher risk for a rare type of vaginal or cervical cancer, and therefore require continued, annual screening with a specialized Pap test regardless of age. Women who are immunocompromised due to conditions like HIV infection, organ transplant, or long-term corticosteroid use, have a higher risk of persistent HPV infections and cervical cancer. For these individuals, more frequent and lifelong cervical cancer screening is recommended, potentially continuing until age 74 or beyond.
If a woman has had a hysterectomy, whether continued Pap smears are needed depends on the type and reason. If a total hysterectomy (removal of the uterus and cervix) was performed for benign conditions, routine Pap tests are no longer required. However, if the hysterectomy was performed due to cervical cancer or high-grade precancerous lesions, or if the cervix was left intact during a subtotal hysterectomy, continued screening is necessary. An inadequate history of prior screening before age 65 also means continued screening is advised.
Comprehensive Gynecological Care Beyond Pap Smears
Even if a 70-year-old woman no longer requires routine Pap smears, continued regular gynecological check-ups remain important for overall health. These visits address other health aspects relevant to older women. Gynecologists can address common concerns such as menopausal symptoms, including hot flashes and vaginal dryness.
Pelvic floor health and issues like urinary incontinence can be discussed and managed during these appointments. Beyond cervical cancer, gynecological visits provide opportunities for screening for other cancers, such as breast cancer and endometrial cancer, and for bone density screenings to assess for osteoporosis. Regular check-ups offer general health counseling, including advice on heart health, nutrition, and exercise, and discuss any new or concerning symptoms that may arise.