Women older than 65 generally don't need to continue Pap tests

DEAR MAYO CLINIC: I am way past my childbearing years and do not have any health problems. Do I need to continue getting Pap smears? At what age is this test no longer necessary?

ANSWER: Getting regularly scheduled Pap smears is important for almost all women. That said, whether you need to continue getting Pap smears, also called Pap tests, depends on your age, risk factors for cervical cancer and results of past Pap tests.

Pap smears often can catch cervical cancer in its earliest stages, many times before it has even progressed to being cancer. Therefore, they are one of the most reliable prevention steps you can take to protect yourself against cervical cancer.

During a Pap test, your health care provider uses a brush to retrieve cell samples from your cervix to look for abnormal changes. Pap tests also may be combined with an HPV or human papillomavirus test, which looks for the presence of high-risk strains of the sexually transmitted virus HPV, which is the biggest risk factor for cervical cancer.

Women should start getting Pap smears when they turn 21unless they are infected with HIV or if their immune system is compromised. Women 21 to 29 with previous normal Pap smear results should have the test every three years. For women 30 and older, a Pap smear may be performed every three years as well; however, sometimes the Pap smear is recommended every five years if the procedure is combined with testing for HPV.

In general, women older than age 65 don't need Pap testing if their previous tests were negative and they have had three Pap tests, or two combined Pap and HPV tests, in the preceding 10 years. However, there are situations in which a health care provider may recommend continued Pap testing.

Women with a history of cervical cancer or high-grade, abnormal Pap tests over the past 20 years should continue cervical cancer screening. Other women at high risk who should continue screening past 65 include those with a compromised immune system and those who were exposed before birth to diethylstilbestrol (DES) - a drug given in the U.S. between 1940 and 1971 to prevent pregnancy complications. In addition, women over 65 who are sexually active with multiple partners should talk with their health care provider about continuing Pap testing.

If you've had a complete hysterectomy, which means the uterus and cervix have been removed, you don't need a Pap test again unless you have had cervical cancer, DES exposure or high-grade abnormal Pap tests over the past 20 years. Most women don't need a Pap test after a hysterectomy, especially if the hysterectomy was for a noncancerous (benign) condition, such as uterine fibroids or bleeding. If a vaginal Pap test is needed, your health care provider will collect a sample from the upper part of the vagina, called the vaginal cuff.

As always, it's best to consult with your health care provider about your individual risks and recommendations for screening. - Beatriz Stamps, M.D., Gynecology, Mayo Clinic, Phoenix