A Pap smear, also known as a Pap test, is a procedure designed to screen for cervical cancer by collecting cells from the cervix. This test is highly effective for identifying precancerous conditions, allowing for treatment before cancer becomes invasive. Current medical guidelines establish specific criteria, combining age and a history of negative results, that must be met before a woman can safely discontinue this routine screening.
Age and History Requirements for Stopping
The standard age guideline for considering the cessation of routine cervical cancer screening is 65 years old. However, age alone is not sufficient; a woman must also have a well-documented history of recent negative results. This ensures that any slow-growing precancerous lesions have been successfully identified and cleared throughout her earlier screening history.
To stop screening at age 65, a woman must have had either three consecutive negative Pap tests alone or two consecutive negative co-tests within the previous ten years. A co-test involves performing both a Pap test and a Human Papillomavirus (HPV) test, which screens for the high-risk viral strains that cause cervical cancer.
The most recent qualifying test must have occurred within the past three to five years, depending on the specific testing method used. If a woman lacks adequate documentation of these normal results, screening must continue until the required history is established, regardless of age. These guidelines apply specifically to women considered at average risk, meaning they have no prior history of high-grade abnormalities or other significant risk factors.
Hysterectomy and Screening Discontinuation
A hysterectomy introduces a separate set of criteria for when Pap smear screening can be discontinued. The decision depends entirely on whether the cervix was removed and the reason for the surgery.
If a woman has undergone a total hysterectomy (removal of both the uterus and the cervix) for benign conditions such as fibroids or heavy bleeding, she is advised to stop routine Pap testing. Removing the cervix eliminates the risk of cervical cancer for most patients.
In contrast, women who had a supracervical or partial hysterectomy, where the cervix remains intact, must continue with routine screening. The continued presence of the cervix means the risk of developing cervical cancer remains. Screening must also continue if the hysterectomy was performed due to a history of cervical cancer or high-grade precancerous lesions.
When Screening Must Continue Past Standard Guidelines
Certain medical histories and conditions necessitate continued cervical cancer screening past age 65 or after a total hysterectomy. These exceptions apply because the underlying risk for developing cancer remains elevated in these populations.
History of High-Grade Abnormalities
A primary exception is a woman with a history of high-grade cervical intraepithelial neoplasia (CIN 2 or CIN 3) or cervical cancer. Guidelines recommend continuing screening for a full 20 to 25 years following the successful completion of treatment. This extended surveillance is required because the risk of recurrence or a new, related cancer remains elevated for decades.
Immunocompromised Status
Women who are immunocompromised should not stop screening based on standard age or history criteria. This includes individuals who are HIV positive, have received an organ transplant, or are on long-term immunosuppressive medication. Their weakened immune system makes them less capable of clearing the HPV infection, increasing their lifetime risk of developing cancer. In these high-risk scenarios, a healthcare provider will determine a specialized, often more frequent, screening schedule.
Post-Pap Smear Gynecological Care
Even after a woman meets all the criteria to safely discontinue Pap smear testing, regular gynecological care must continue. Stopping cervical cancer screening does not mean discontinuing routine visits to a gynecologist or primary care provider.
These annual or biennial appointments remain important for a range of other preventative health measures. Routine visits include a general health assessment, breast examinations, and pelvic examinations. These exams check for issues with the ovaries, uterus, and vagina, and can detect conditions such as ovarian cysts, uterine fibroids, or signs of vaginal atrophy related to menopause.
Discontinued Pap testing also does not negate the need for continued general health screenings, such as blood pressure checks, cholesterol monitoring, and osteoporosis assessments. Women must remain vigilant for any abnormal symptoms, such as unexpected vaginal bleeding, pain during intercourse, or unusual discharge. These symptoms should always prompt an immediate visit to a healthcare provider, regardless of age or screening history.