WASHINGTON, DC (December 17, 2025)—For several years, guidelines recommended that providers could stop conducting cervical cancer screening for patients age 65 and up only if medical records showed several years of negative tests. However, these guidelines were difficult to follow, leading the American Cancer Society to recently update its recommendations. The guidelines now recommend performing screening at age 60 and age 65 with HPV testing without requiring review of past history. Additional screening may be warranted for high-risk patients. In a study selected as the Editor’s Choice for the November/December Women’s Health Issues, the authors surveyed clinicians to determine what proportion followed the older guidelines and interviewed several of them to learn more about their considerations in exiting patients from screening.
Women’s Health Issues is the official journal of the Jacobs Institute of Women’s Health, which is based at the Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University.
Abigael Olson, MD, of Boston Medical Center, and colleagues surveyed 1,251 clinicians in 2021 about their cervical cancer screening practices and conducted interviews with 55 of them. They asked survey respondents to select from a list of options to indicate which criteria they applied to determine whether a patient could stop getting screened via either Pap tests (which look for abnormal cervical cells) or combination Pap and HPV tests (which also detect the presence of the strains of human papillomavirus that cause most cervical cancers). Guidelines advised that patients aged 65+ could exit screening if they had either three consecutive negative Pap tests or two consecutive negative Pap+HPV tests within the past 10 years — but only if they had not been treated for cervical cancer or high-grade precancerous lesions in the past 25 years.
Olson and colleagues found that 75% of survey respondents correctly identified criteria for prior negative screening, but only 35% responded correctly to all screening exit items. Interviewees noted that often patients aren’t able to assemble the necessary medical records, and they also gave several reasons for continuing screening even among those who qualified for screening exit. These reasons included patients with recent new sexual partners, having had a past patient who developed cervical cancer after age 65, and patients’ wanting to continue screening.
“These findings demonstrate how important it is to not only base guidelines on evidence, but to study guideline implementation,” said Karen McDonnell, Editor-in-Chief of Women's Health Issues and Associate Professor of Prevention and Community Health at Milken Institute SPH. “The combination of a large national survey with interviews allows us to understand not only how well guidelines are implemented but what kinds of barriers to implementation clinicians face.”
“This study highlighted the difficulties with following older guidelines for screening exit. We hope that the new, simpler American Cancer Society recommendations may improve screening rates and save lives,” said Rebecca Perkins MD, Professor of Obstetrics and Gynecology at Tufts Medical Center and senior author of the study.
“Factors Associated With Guideline-Concordant Cervical Cancer Screening Exit: A Mixed Methods Study” has been published in the November/December 2025 issue of Women’s Health Issues.