Many providers wonder if women should continue having pap smears and mammograms after age 65. Many of us also wonder what are the most up to date ways to screen women for ovarian cancer. It’s important to note that guidelines are just that, guidelines based upon data from large populations, however they may not apply to every woman that you encounter, especially to those who have unique circumstances and let’s face it, are more challenging and more rewarding as we provide personalized, individualized care. The current American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines for pap smears differ from those of the US Preventive Services Task Force (USPSTF)
The USPSTF guidelines recommend that Pap smears be stopped at age 65 if there have been adequate prior screens, however it’s not clear what the definition is of adequate prior screens.
The ASCCP guidelines recommend that women stop pap testing at age 65 only if there have been 3 consecutive neg Paps or 2 consecutive neg HPV tests, the most recent within 5 years. Their guidelines do not include women who have had any CIN 2 or worse within the last 20 years. They also recommend stop at age 65 after hysterectomy for benign disease.
Over 40% of breast cancers are diagnosed in women over 65. Guidelines for mammograms from the American Cancer Society state that age alone should not be the reason to stop, provided the woman has no serious, chronic health problems. The USPSTF states that women should have mammography very 2 years from 50-74, and that for women 75 and older, the current evidence is insufficient to assess benefits and harms from over diagnosis and possible unnecessary procedures, biopsies and treatments.
See Barb Dehn, RN, MS, NP, FAANP, NCMP speak at a Skin, Bones, Hearts & Private Parts conference in 2017.