Pap Smears Come with an Expiration Date: Who Knew?

Debbie says:

medical cross-section of female reproductive system

I was completely surprised to learn a couple of weeks ago that virtually all medical experts suggest that most women stop getting pap smears (vaginal tests for cervical cancer) at age 65. I had one last week at age 64, and it’s probably my last one.

The basic reason for the recommendation to stop is that very few women over 65  develop cervical, ovarian, or uterine cancer.  A review of several studies concluded that the risk is quite small:

According to this review, fewer than 1 in 1000 (and possibly as few as 2 in 10,000) women aged >60 years with a history of a normal baseline Pap smear will develop cervical intraepithelial neoplasia (CIN) 3 or cancer. By comparison, women being screened for the first time had rates of CIN 3 or cancer at 2.3 per 1000 for ages 50 to 64 years, and 1.7 per 1000 for women aged 65 years.

Because this is a literature review, all of the studies had different methodologies and participants, but it seems likely that the participants were not screened for level of sexual activity, because that would probably be called out if it had happened. Since I can’t find any studies that specifically did screen for sexual activity, each of us has to make our own decision without much data.

As I’ve dug further into this, I’ve been interested both in what I can find out, and what I can’t find out, which pretty much reflects what has been studied and published, and what has not.

Here’s what I’ve gleaned:

Cervical cancer specifically is caused by human papilloma virus (HPV). Ovarian and uterine cancers, which also become less frequent as women age, are not HPV-related. All three of these are slow-growing cancers, which means that if one begins to be detectable in your middle 60s, it may not become any kind of a problem until you are 80 or older, at which point many people decide against aggressive cancer treatment.

Some reputable groups and clinics specifically recommend stopping testing regardless of sexual activity. Some recommend continued testing only if you have new or multiple partners. In a New York Times story from 2011, a gynecologist relates a delightful anecdote:

Dr. Feldman was surprised to see an abnormal Pap result in an 80-year-old patient who had been a devoted caregiver for her husband of 55 years, who had dementia. “It seemed like an odd finding,” Dr. Feldman said, until she learned her patient was having an affair with a young man she had met at Starbucks.

You have to pause for a moment to be happy for her; what a way to balance a life with a demented husband! What’s more, both the article and the rest of the literature make it clear that an “abnormal result” is not a cancer diagnosis, though we don’t know what happened to this particular woman.

But back to pap smears. For myself, with no family history of gynecological cancers, and no abnormal pap smears, I’m just done. I can stop putting my heels in the stirrups and scooting my ass down to the edge of the table. And the evidence regarding sexual activity isn’t conclusive enough for me to change this if I suddenly find new partners.  Other women may, of course, make different decisions.