A Pap smear is a routine screening procedure that detects precancerous or cancerous cells on the cervix. It prevents cervical cancer by identifying cellular abnormalities early, allowing timely intervention. While consistent screening is beneficial for many years, it is not a lifelong requirement for every individual. This article explores criteria for discontinuing Pap smears.
General Guidelines for Stopping Pap Smears
For many individuals with a cervix, Pap smear screening can be safely discontinued around age 65. This general guideline applies when there is a documented history of consistent negative screening results over an extended period. This means having at least three consecutive negative Pap tests or two consecutive negative co-tests (Pap test combined with HPV testing) within the last 10 years. The most recent test should have occurred within the last three to five years.
These recommendations are supported by leading medical organizations, including the American College of Obstetricians and Gynecologists (ACOG) and the American Cancer Society (ACS). The rationale behind stopping at this age is the significantly reduced risk of developing new cervical abnormalities in older individuals who have consistently screened negative. Discuss individual medical history and screening cessation with a healthcare provider.
Stopping After a Hysterectomy
A hysterectomy, the surgical removal of the uterus, can also be a reason to discontinue Pap smears. This applies to individuals who have undergone a total hysterectomy, involving complete removal of both the uterus and the cervix. Screening ceases if the hysterectomy was for benign (non-cancerous) conditions. There must also be no history of moderate or severe cervical dysplasia (CIN 2 or CIN 3) or prior cervical cancer.
If a hysterectomy was subtotal, meaning the cervix was left intact, regular Pap smears will still be necessary. Similarly, if the hysterectomy was performed due to a diagnosis of cervical cancer or high-grade precancerous lesions, continued surveillance with vaginal vault smears may be recommended. A healthcare provider determines follow-up based on the hysterectomy type and medical history.
When Continued Screening is Necessary
Even with general age or hysterectomy criteria met, some circumstances require continued Pap smear screening. Individuals with a history of abnormal Pap tests, particularly those involving high-grade lesions or diagnosed cervical cancer, should continue regular surveillance. This monitors for recurrence or new abnormalities.
Another instance requiring continued screening is exposure to diethylstilbestrol (DES) in utero, a synthetic estrogen once prescribed to pregnant women. This increases the risk of certain gynecological cancers. Individuals with a compromised immune system (e.g., HIV infection, organ transplant recipients, or those on immunosuppressive medications) also require ongoing Pap tests due to heightened HPV-related disease risk. These conditions override general guidelines for discontinuing screening.
Maintaining Gynecological Health
Discontinuing Pap smears does not signal the end of regular gynecological care. Ongoing visits with a healthcare provider are important for overall reproductive health. These appointments offer an opportunity to discuss new or concerning symptoms, such as abnormal bleeding, pelvic pain, or changes in vaginal discharge.
Regular pelvic exams assess the health of reproductive organs and surrounding structures. Breast exams are also part of routine gynecological care. While Pap smears may cease, HPV testing could still be relevant for some individuals, either as part of earlier co-testing protocols or in specific situations. Maintaining open communication with a healthcare provider about health concerns is recommended.