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Pap Test: Stop at Age 65? Maybe Not

by Berkeley Wellness  

Most women over 65 who are at average risk for cervical cancer should stop having routine Pap tests, according to leading expert groups (the U.S. Preventive Services Task Force, the American Cancer Society, and the American College of Obstetricians and Gynecologists), but only if they have been adequately screened for the cancer during the past decade and had no abnormal results. However, based on 2015 data, many American women ages 61 to 65 have not been adequately screened, including 18 percent not screened within the past five years, according to a new study in the American Journal of Preventive Medicine. Despite that, they often stop getting tested at 65, which helps explain why many older women still develop otherwise-preventable invasive cervical cancer and some continue to die from it.

Adequate screening with normal results means three consecutive Pap results (recommended every three years when results are normal) or two consecutive “co-test” results (Pap plus HPV test, once every five years) within the previous 10 years, with the most recent test done within the past five years.

Women who have not been adequately screened should have “catch-up” screening after age 65. That includes the 5 percent of American women ages 66 to 70 who have never been screened for cervical cancer.

In addition, if abnormal results are found, women need more frequent testing and need to continue past age 65, as do women at elevated risk, such as smokers or those with compromised immunity.

“A recommended upper age limit for routine screening may lead women and providers to assume that cervical cancer is a younger woman’s disease,” the CDC re­­searchers wrote. But “some of the highest cervical cancer incidence rates occur among women aged 65 years and older, with notably higher rates among older black women.”

That said, other research has found that millions of average-risk women who have been adequately screened and had normal results continue after age 65, though they needn't. And women who have had a total hysterectomy (cervix removed) do not need to be screened for cervical cancer, though most continue.

Women should discuss their cervical cancer screening schedules with their health care providers. There is no one-size-fits-all advice. With proper screening, invasive cervical cancer and deaths from it are almost completely preventable.

Also see Screening Tests: How Old Is Too Old?