The Pap test, or Pap smear, is a screening tool designed to detect precancerous changes and cancer in the cells of the cervix. These changes are primarily caused by persistent infection with high-risk types of the human papillomavirus (HPV). Identifying and treating these abnormal cells early makes the test highly effective at preventing cervical cancer. Current medical guidelines establish clear criteria based on age, past screening results, and medical history for when routine screening can safely be discontinued.
When Age and History Allow Stopping
The standard age at which individuals are advised to stop routine cervical cancer screening is 65 years old. However, ceasing screening at this age is conditional, not automatic, and depends entirely on a documented screening history. This recommendation is based on the understanding that the risk of developing new cervical disease significantly decreases in older individuals who have been consistently screened.
To safely discontinue testing, an individual must have an adequate history of negative results preceding age 65. This requires either three consecutive negative Pap test results or two consecutive negative co-test results (combining the Pap test with an HPV test). These results must have occurred within the ten-year period before stopping, with the most recent test performed within the last five years.
A person must also have no history of a high-grade precancerous lesion, specifically Cervical Intraepithelial Neoplasia grade 2 (CIN 2) or grade 3 (CIN 3), or cervical cancer. A history of any of these conditions within the preceding 20 to 25 years generally disqualifies stopping screening at age 65. If a patient meets all the criteria, the risk of developing cervical cancer is considered low enough that the harms of continued screening outweigh the benefits.
Screening After Hysterectomy
The decision to stop cervical cancer screening after a hysterectomy depends on two factors: whether the cervix was removed and the reason for the surgery. Many people believe a hysterectomy automatically eliminates the need for Pap testing, but this is only true in specific circumstances. Screening may be discontinued only if a total hysterectomy was performed, meaning both the uterus and the cervix were surgically removed.
The second condition is that the hysterectomy must have been performed for a non-cancerous (benign) reason, such as uterine fibroids or endometriosis. If the cervix was removed for benign reasons, the tissue at risk is gone, and routine screening is no longer necessary. Conversely, if a person had a partial or subtotal hysterectomy where the cervix was left in place, screening must continue according to standard age-based guidelines because the risk remains.
If the hysterectomy was performed to treat a high-grade precancerous lesion (CIN 2 or CIN 3) or an existing cervical cancer, routine screening must continue indefinitely. Even with the cervix removed, specialized screening is performed on the vaginal cuff (the top of the vagina) to monitor for any recurrence or progression of disease. This screening involves a vaginal vault sample, which looks for abnormal cells in the remaining tissue.
Situations Where Screening Must Continue
Certain medical risk factors and health conditions override standard age and surgical guidelines, requiring continued cervical cancer screening. Individuals with a history of high-grade disease (CIN 2, CIN 3, or adenocarcinoma in situ) must continue surveillance for at least 20 years following successful treatment. This extended surveillance is necessary because the risk of a new or recurrent lesion persists for decades, even past age 65.
Individuals with compromised immune systems also require continued and often more frequent screening. This includes people living with Human Immunodeficiency Virus (HIV) or those who have undergone solid organ transplantation and are taking immunosuppressant medications. A weakened immune system makes it more difficult for the body to clear the HPV infection, leading to a higher and prolonged risk of precancerous cell changes.
Another group requiring continued screening are those exposed in utero to the drug Diethylstilbestrol (DES). DES was a synthetic estrogen prescribed to pregnant women between 1940 and 1971. Daughters exposed to DES face an increased lifetime risk of developing rare types of clear cell adenocarcinoma of the vagina and cervix. Due to this persistent, elevated risk, these individuals must continue specialized screening regardless of age or prior hysterectomy status.