A Pap smear, or Papanicolaou test, is a routine screening procedure designed to detect precancerous or cancerous changes in the cells of the cervix. This test is a fundamental part of preventive health, playing a major role in lowering the incidence and mortality rates of cervical cancer. By identifying abnormal cell changes early, healthcare providers can intervene before cancer develops. The decision to stop this screening is based on specific health history criteria rather than just reaching a certain age.
When Routine Screening Typically Ends
Major health organizations suggest that individuals with an average risk can stop routine cervical cancer screening around age 65. Simply reaching this age is insufficient; cessation requires a documented history of consistently negative results to ensure the risk of developing future cervical cancer is low. Guidelines define “adequate prior screening” as three consecutive negative Pap tests or two consecutive negative co-tests (combining a Pap test with an HPV test) within the last 10 years.
The final test in this series must have been performed within the five years immediately preceding the decision to stop screening. This prolonged period of negative results provides confidence that any existing high-risk HPV infection, which causes almost all cervical cancers, has cleared. Once these criteria are met, the benefits of continued screening are outweighed by potential harms, such as unnecessary anxiety or invasive follow-up procedures. If screening stops at age 65, it is not recommended to resume testing later, provided the individual remains low-risk.
Cessation Due to Surgical History
Cervical cancer screening may cease following a hysterectomy that includes the removal of the cervix. Since a Pap smear screens the cervix, routine screening is unnecessary if the entire cervix is removed, provided the surgery was performed for benign reasons. Common benign reasons include uterine fibroids or heavy menstrual bleeding. In this scenario, the risk of developing cancer in the remaining vaginal tissue is low, making routine screening unwarranted.
It is important to understand the type of hysterectomy performed, as not all procedures remove the cervix. A supracervical or subtotal hysterectomy removes the uterus but leaves the cervix intact, meaning regular Pap and HPV testing must continue. If the hysterectomy was performed due to a history of cervical cancer or high-grade precancerous lesions, screening must continue post-surgery. This continued monitoring often involves a vaginal vault smear to check for recurrence in the vaginal tissue.
Situations Requiring Continued Screening
Despite general guidelines for cessation, certain medical histories require continued screening indefinitely due to a higher risk of developing cervical or vaginal cancer. One major exception involves a history of high-grade precancerous lesions, such as cervical intraepithelial neoplasia grade 2 or 3 (CIN 2 or CIN 3). For these individuals, screening should continue for at least 20 to 25 years after the abnormal cells were found, even if this extends past age 65.
Continued testing is also required for individuals who are immunocompromised, such as those with HIV infection or those using long-term immunosuppressant medications after an organ transplant. A weakened immune system makes it difficult to clear HPV infection, increasing the likelihood of cell changes progressing to cancer. Individuals exposed to the drug diethylstilbestrol (DES) in utero also fall into the high-risk category and must continue screening due to an increased risk of a rare type of vaginal cancer. Anyone with a history of cervical cancer must continue follow-up testing, often involving vaginal vault smears, as recommended by their oncology team.
Maintaining Health After Pap Smear Cessation
Discontinuing Pap smears does not end routine gynecological care, but shifts the focus of preventive health. The routine well-woman exam remains necessary for overall health monitoring. These visits transition from cervical screening to addressing other age-related health concerns.
During these appointments, the provider will perform a general pelvic examination and discuss important topics like menopause management, sexual health, and urinary symptoms. This is also the time to ensure other cancer screenings are up to date, such as mammography for breast cancer and colon cancer screening. Continued regular visits ensure that health risks are assessed and managed proactively, promoting overall wellness long after cervical cancer screening has been safely discontinued.