Cervical Cancer Screening Guidelines for Women with Abnormal Pap History

Screening Frequency and Cessation Criteria

The American College of Obstetricians and Gynecologists recommends that women with a history of abnormal Pap smears continue cervical cancer screening every 3 years with Pap testing alone or every 5 years with co-testing (Pap plus HPV), and cannot discontinue screening at age 65 unless they have documented adequate negative screening for at least 20 years after their last abnormal result 1, 2
Women aged 30-65 years should undergo preferred screening with Pap test plus HPV DNA test (co-testing) every 5 years or acceptable screening with Pap test alone every 3 years 3, 4, 5, 6
The American Cancer Society recommends that women can stop screening at age 65 if they have had ≥3 consecutive negative Pap tests OR ≥2 consecutive negative HPV and Pap co-tests within the last 10 years, with the most recent test in the last 5 years 6, 4, 1

Women with a history of CIN2, CIN3, or adenocarcinoma in situ must continue routine screening for at least 20 years after treatment, even if this extends screening past age 65 1, 2
Women with a history of lower-grade abnormalities (ASC-US, LSIL, or CIN1) must demonstrate adequate negative screening (3 consecutive negative Paps or 2 negative co-tests over 10 years) AFTER resolution of the abnormality before cessation criteria apply 1, 2

Women with immunosuppression (HIV, transplant recipients, chronic steroid use), history of multiple sexual partners, smoking, pessary use, or high-risk ethnicity (Vietnamese or Hispanic women) may require continued screening beyond age 65 even with adequate negative screening history 7, 1

Continued screening in women with prior abnormal Paps is justified due to the mortality benefit, with a meaningful absolute risk reduction in this population 1