A Pap smear, also known as a Pap test, is a procedure used to screen for cervical cancer. The test involves collecting cells from the cervix to look for abnormal changes that could potentially develop into cancer. Understanding the correct screening schedule is particularly important for women at age 70 because medical guidelines recommend that most women in this age group can safely stop routine testing. The decision to discontinue screening is based on a woman’s medical history and the knowledge that the risk of developing cervical cancer decreases significantly after age 65.
Standard Age Guidelines for Discontinuing Screening
Major health organizations, including the U.S. Preventive Services Task Force (USPSTF), recommend that most women stop cervical cancer screening after age 65. This recommendation is based on evidence that women who have been consistently screened throughout their lives have an extremely low probability of developing the disease later. For a 70-year-old woman to safely discontinue routine Pap smears, she must have a documented history of adequate negative prior screening results.
Adequate negative prior screening requires no history of a high-grade precancerous lesion or cervical cancer. She must also have had either three consecutive negative Pap tests or two consecutive negative co-tests within the previous 10 years. The final test in this series must have occurred within the last five years to ensure the risk assessment is current.
The reason for stopping screening in this group is that the slow-growing nature of cervical cancer means that a woman with a decade of negative results is highly protected. Continuing to screen when the risk is low introduces the potential for false-positive results, leading to unnecessary anxiety and invasive follow-up procedures.
Medical History That Necessitates Continued Testing
Specific medical histories require a 70-year-old woman to continue regular cervical cancer testing, even past age 65. A primary exception is a history of a high-grade precancerous lesion, such as Cervical Intraepithelial Neoplasia Grade 2 (CIN 2) or Grade 3 (CIN 3). In these cases, screening should continue for a full 20 years after the lesion was treated and cleared.
Women with a compromised immune system must also continue regular screening indefinitely. This includes individuals who are HIV positive or are taking immunosuppressive drugs due to an organ transplant or chronic condition. Similarly, a woman exposed in utero to Diethylstilbestrol (DES) must continue screening indefinitely due to a higher lifetime risk of a rare type of cervical or vaginal cancer.
Guidelines also differ if a woman has had a hysterectomy (surgical removal of the uterus). If the total hysterectomy included the removal of the cervix and was performed for a benign reason (e.g., fibroids), screening can stop. If the hysterectomy was performed due to cervical cancer or a serious precancerous condition, the physician will typically recommend continued screening of the vaginal vault.
How HPV Status Impacts Screening Decisions
The Human Papillomavirus (HPV) is the cause of nearly all cervical cancers, making the status of this virus a central factor in screening decisions. Modern screening often involves co-testing, which combines the traditional Pap test with an HPV test to detect the virus itself. A negative HPV test provides a stronger guarantee of low future risk than a Pap test alone because the virus must be present for the cancer to develop.
For a 70-year-old woman who has an uncertain or insufficient screening history, a negative high-risk HPV test can be the final confirmation needed to safely cease testing. The current standard for stopping is achieved when a woman has two consecutive negative co-tests within the last decade. A single negative HPV test is highly reassuring and may be sufficient for a physician to recommend stopping, depending on the individual patient’s circumstances.
If a woman has not met the criteria for cessation by age 65, she should continue screening until she achieves the required number of negative results. For women in their late 60s and 70s who have not been screened regularly, some healthcare providers may recommend a “catch-up” HPV test to confirm a low risk before officially retiring from cervical cancer screening. The presence of a high-risk HPV type is a significant reason to continue monitoring, regardless of age.
Health Monitoring After Routine Pap Smears End
Stopping routine cervical cancer screening does not mean discontinuing all gynecological care. Ongoing monitoring is important for detecting other women’s health issues, particularly cancers not screened for by a Pap test. Women should continue to have an annual well-woman visit, which typically includes a clinical breast exam and a pelvic exam.
During the pelvic exam, the physician checks the vulva, vagina, and surrounding pelvic organs for any abnormalities. This is important because the Pap test does not screen for endometrial, ovarian, or vulvar cancers. These annual exams provide an opportunity for a general health review and important discussions about bone health, menopause symptoms, and cardiovascular risk.
Women must remain vigilant for specific symptoms, even after Pap smears have ceased. Abnormal vaginal bleeding, especially any bleeding after menopause, should be reported to a doctor immediately, as this is the most common symptom of endometrial cancer. Other symptoms, such as persistent pelvic pain, unusual discharge, or changes in bowel or bladder habits, warrant prompt medical evaluation to rule out other gynecological issues.