Doctors Say Most Women Over 65 Don’t Need Pap Smears—Cancer Rates Say Otherwise
90 percent of cervical cancer cases are caused by HPV, which is rising in older women.
When did a routine Pap smear become not so routine? Research shows that cervical cancer (which is first detected via a Pap smear) has a higher prevalence in women between the ages of 70 and 79, compared with women in their 20s. It’s estimated that 20 percent of cases occur in women aged 65 and up. These statistics are reason enough to schedule a Pap smear—and yet, many doctors say women over 65 don’t need them. It’s puzzling, so let’s break it down.
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How do Pap smears detect cervical cancer?
Cervical cancer occurs when “cancerous tissue forms on the surface of your cervix,” explains Cleveland Clinic. There are two main kinds of cervical cancer: squamous cell carcinomas (responsible for 80-90 percent of cases) and adenocarcinomas (much less common, only responsible for 10-20 percent of cases). It’s also possible to have a combination of both types.
Cleveland Clinic estimates that 14,000 adults in the U.S. are diagnosed with cervical cancer each year. Early signs of cervical cancer may include:
- Watery/bloody vaginal discharge with a foul odor
- Abnormal bleeding
- Painful sex
In more advanced cases (i.e., if the cancerous cells start attacking nearby tissues and organs), patients may experience:
- Difficulty urinating
- Diarrhea
- Fatigue
- Weight loss
- Backaches
- Swelling in the legs
- Pelvic/abdominal pain
During a Pap smear, your doctor will collect cells from your cervix that will be sent off to a lab for cervical cancer and precancerous lesion testing. “Getting Pap tests and practicing safe sex are the most important steps you can take to help prevent cervical cancer,” says Cleveland Clinic.
Because, did you know that HPV causes up to 90 percent of all cervical cancers?
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New research shows that women over 65 are at a greater risk of developing cervical cancer.
According to Cleveland Clinic, there are over 100 different strains of HPV, a dozen of which have been linked to cervical cancer.
In fact, a new study published in the journal Gynecology and Obstetrics Clinical Medicine found that women over the age of 65 are more likely to test positive for HPV than women 64 and younger.
The observational study examined over 2.1 million cervical cancer screening records. Patients were divided into two age groups: those 65 and older, and those younger than 65. From there, researchers compared their Pap smear results to see which of the age groups “bear a higher cervical cancer burden.”
Here’s what they found:
- The 65 and older group had a higher prevalence of high-risk HPV infections and abnormal cells.
- 14 percent of the older age group tested positive for HPV vs. only 8 percent of the younger age group.
- Those 65 and up were more likely to be diagnosed with multiple types of HPV.
- They also had more cell abnormalities show up in screenings, compared to their younger peers.
Data show that “women [aged 65 and above] are a high-risk group for cervical cancer incidence and mortality,” states the study.
“Most guidelines suggest stopping screening for those with adequate primary screening and no high-risk factors, particularly for women under 65,” wrote the authors. “However, the situation differs for those over 65, who may not have been vaccinated or thoroughly screened. With increasing life expectancy, the risk of cervical cancer in this demographic is significantly heightened.”
Even with all this research readily available, some doctors still say many women over 65 don’t need Pap smears, including those at the Centers for Disease Control and Prevention (CDC).
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How often should I get a Pap smear?
Globally, cervical cancer is the fourth most common cancer affecting women. The World Health Organization (WHO) reported that in 2022, there were about 660,000 new cases of cervical cancer, more than half of which ended in death. Furthermore, women with HIV (human immunodeficiency virus) have a six times greater risk of developing cervical cancer.
The good news is cervical cancer is easily treatable if it’s caught early; however, early detection is only possible with regular Pap tests. It’s super confusing because cervical cancer rates in women over 65 are rising, yet this age bracket is often told by doctors that routine Pap smears aren’t necessary.
The U.S. Preventive Services Task Force (USPSTF) recommends that women get routine Pap smear tests every three years, starting at age 21. However, your doctor may suggest more frequent screening if you have a history of abnormal test results.
Once you hit age 65, your doctor may say routine cervical screening isn’t necessary. Some caveats to this rule may be:
- You have HIV
- You’re immunocompromised
- A recent Pap smear or biopsy came back abnormal
- You’ve been previously diagnosed with cervical cancer
- You have a family history of cervical cancer
Guidelines aside, it’s imperative you raise any health concerns to your doctor’s attention. Remember that prevention is key, and you have options.
“Pap tests can detect precancerous cell changes before they have a chance to turn into cancer. If you’re keeping up with regular Pap tests, cervical cancer isn’t likely to go unnoticed,” says Cleveland Clinic.
