Should You Continue Cervical Cancer Screening After Age 65?

Research shows that two-thirds of older women who stop screening remain at risk for cancer

Liz Szabo,

AARP

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En español

Published April 24, 2025

A gloved medical professional examines a sample as a woman sits atop a lab chart

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Many women stop screening for cervical cancer at 65 because they assume they are no longer at risk. But experts say that’s not always the case, and that some older women could benefit from continued screenings.

In fact, 25 percent of cervical cancer diagnoses occur in women over the age of 65, and cervical cancers diagnosed in this age group tend to be more advanced than those found in younger women, making them more difficult to treat. Rebecca Perkins, M.D., a professor of obstetrics and gynecology at Tufts University School of Medicine, says most women diagnosed with cervical cancer haven’t been screened recently.

Although age 65 is often seen as a stopping point for cervical cancer screening, national guidelines from groups such as the American Cancer Society say that women must meet several criteria before safely discontinuing screening.

These criteria include documentation of adequate screening for the past 10 years and no history of cervical cancer or precancer in the past 25 years. Perkins says women who are being followed for abnormal screening results should continue being examined past age 65 or as long as their doctors recommend. Women with weakened immune systems may also need additional testing, Perkins adds.

The society defines adequate screening as documentation of two negative HPV tests or three negative Pap tests within the past decade, with the most recent test performed within the past five years. While HPV tests can detect infections with the virus that causes most cervical cancers, Pap tests collect cells from the cervix and can detect cancers and precancers.

“That is a lot of tests to pass before exiting screening,” Perkins says.

Only 1 in 3 women ages 64 to 66 meet these criteria, meaning that two-thirds of women who stop screening at 65 may still be at risk for cervical cancer, Perkins says. Women who stop screening without meeting the criteria by age 65 are twice as likely to develop cervical cancer before age 85 compared to women who are adequately screened.

In some cases, women don’t meet the criteria to stop cervical cancer screening because they haven’t had a pelvic exam in many years. In other cases, their medical records don’t document that these exams occurred, sometimes because women have changed health plans in the past decade and their doctors can’t access their previous electronic record system, Perkins says.

“On average, people stay in the same health system or insurance provider only three to four years,” Perkins says. “If you have a screening interval of five years, it’s easier for people to get lost.”

Cervical cancer was often assumed to be a disease of younger women because many post-menopausal women had hysterectomies that removed the cervix, Perkins says. However, fewer women are undergoing hysterectomies these days; others are eligible for hysterectomies that remove the uterus but leave the cervix intact, Perkins says.

The American Cancer Society estimates that 13,360 new cases of cervical cancer will be diagnosed this year, along with 4,320 deaths from the disease. The average age of diagnosis for cervical cancer is 50.

When should you schedule a screening appointment?

Twenty years ago, it was easy for women to remember when to get a cervical cancer screening, because they were given one every year. Now that screenings are recommended every three to five years, depending on the type of testing, it’s much harder for women to remember when to schedule an appointment, Perkins says.

Nearly all cervical cancers are caused by HPV, the human papillomavirus. The immune system naturally clears 90 percent of HPV infections within a couple of years.

Cervical cancers tend to grow slowly, progressively through three precancer stages before becoming malignant. Doctors can remove many of these growths before they become life-threatening, which has cut the cervical cancer mortality rate in half over the past 50 years.

In the past, doctors often coupled cervical cancer screening with women’s annual gynecologic exams, which were required for prescription for birth control, says Robert Smith, senior vice president of early cancer detection science at the American Cancer Society.

But women who received abnormal Pap smear results from annual screening experienced unnecessary anxiety and additional medical procedures that didn’t lower cancer incidence or mortality rates. The American Cancer Society updated its guidelines in 2020 to make use of more sophisticated tests and to spare women from unnecessary procedures, Smith says.

New screening recommendations are nuanced and read as if they were written for doctors, not patients.

The American Cancer Society now recommends primary HPV tests — ones approved to be used on their own — every five years from ages 25 to 65. If primary HPV tests aren’t available, women should be screened with “co-testing,” an HPV test combined with a Pap smear, every five years; or with a Pap smear alone every three years.

Women are more likely to develop cervical cancer or precancer if they have HPV infections that persist for more than two years, Perkins says. That’s why women who test positive for HPV receive more frequent follow-up tests.

HPV tests are better at detecting cancer than the older Pap tests. Pap tests can’t detect a problem until cells on the cervix begin to appear abnormal; HPV tests can detect genetic material from the virus before it causes abnormalities.

Today, many women are missing their screenings entirely.

Only about 75 percent of women were up to date on cervical cancer screening in 2021, the most recent year for which data is available. Research shows that cervical cancer screening rates decrease with age; women ages 60 to 64 are less than half as likely to undergo screening as those ages 30 to 39.

Younger women in their childbearing years are more likely to be up to date on cervical screening because they see their doctors more often, Smith says.

Changes in the cervix after menopause can make pelvic exams more uncomfortable, leading some women to skip them, Smith says. Pap tests also may not be as effective in post-menopausal women in detecting adenocarcinoma, a type of cervical cancer that has been increasing in incidence.

Smith notes that the Food and Drug Administration has approved cervical screening tests that women can perform themselves at a doctor’s office, much as they collect their own urine sample. Some women prefer to collect their own cervical cancer sample rather than undergo a pelvic exam, which can be painful for some people.

A lifelong source of risk

HPV is a ubiquitous sexually transmitted virus that also causes vaginal, vulvar, penile, anal and head and neck cancers. Among sexually active people, more than 90 percent of men and 80 percent of women are infected with HPV during their lifetimes.

Many women believe they’re not at risk for HPV-related cancers because they’re no longer sexually active or haven’t had a new partner in many years, Perkins said.

But like the chickenpox virus, which can hide in nerve cells for decades before reactivating and causing a painful condition called shingles, HPV can reactivate decades after the original infection. Reactivations are more common in people who are immune-compromised, and are just as risky as new infections, Perkins says. HPV also “can reactivate because the immune system is distracted doing something else,” Perkins adds.

Most insurance plans, including Medicare and Medicaid, cover cervical cancer screenings. Under the Affordable Care Act, most insurers must cover cervical cancer screenings with no copay.

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