TABLE
Cost-benefit analysis of Pap smear screening
| Patient | Screening frequency | Cost per year of life saved |
|---|---|---|
| All women aged≥65 years | Every 3 years | $7000 |
| Women aged≥65 years without a previous Pap or Pap within 5 years | Every year | <$6500 |
| Women aged≥65 years with a history of normal, regular Pap smear results | Every 3 years | $33,572 |
Recommendations from others
The 2002 guidelines from the American Cancer Society recommend that women aged 70 and older who have had 3 consecutive normal Pap smear results and no abnormal results in the past 10 years may choose to stop cervical cancer screening.9 The 2003 guidelines from the US Preventive Services Task Force recommend discontinuing Pap smear screening after age 65 if previous Pap results were consistently normal.10 In 1994, the Canadian Task Force on Preventive Health Care recommended stopping screening at age 70 if women have had at least 4 negative Pap smear results in the preceding 10 years and if previous results were normal.11 The American College of Obstetrics and Gynecology recommends physicians determine when to stop screening on an individual basis, and notes that limited studies of older women made it difficult to set an upper age limit for Pap smears.12
Medicare covers Pap smears every 3 years, but will pay for yearly screening for women who have had an abnormal Pap result in the preceding 3 years and for women at high risk of cervical or vaginal cancer.
CLINICAL COMMENTARY
Stop Pap smears at 65 for those with normal prior screening, low risk for HPV
Jon O. Neher, MD
Valley Medical Center Family Practice Residency, Renton, Wash
My older patients are delighted to stop having Pap smears and want to quit as soon as possible. The test can become quite an ordeal with advancing age as cervical stenosis, vaginal atrophy, and hip arthritis increase patient discomfort and technical difficulty. Following the lead of the US Preventive Services Task Force, I stop recommending them at age 65 for most patients who have a record of recent normal Pap smear results.
However, older adults are sexual beings, and HPV transmission can occur among those who are sexually active outside a long-term mutually monogamous relationship. When counseling women with high-risk lifestyles, I will discuss the possibility of continuing regular Pap smears beyond 65 years of age.