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Difficulty: EasyPreventive Care and Screening

An internist evaluates a 66-year-old female patient who recently relocated to the area and wants to establish primary care. She has an intact uterus and cervix. She provides comprehensive medical records from her previous provider. Review of these records shows negative cervical cytology and human papillomavirus (HPV) co-testing at ages 55, 60, and 64. She has never had an abnormal Papanicolaou test or a history of cervical dysplasia. She is currently sexually active with her husband of 40 years. Which of the following is the most appropriate next step regarding cervical cancer screening for this patient?

  1. Discontinue cervical cancer screeningAnswer
  2. B
    Perform cervical cytology alone today
  3. C
    Perform cervical cytology and HPV co-testing today
  4. D
    Schedule cervical cytology and HPV co-testing at age 69
  5. E
    Perform primary high-risk HPV testing alone today

Answer

Discontinue cervical cancer screening.
The correct action is to discontinue cervical cancer screening. According to the United States Preventive Services Task Force (USPSTF), routine screening for cervical cancer should be discontinued in women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer (e.g., history of high-grade precancerous lesions, in utero diethylstilbestrol exposure, or immunocompromise). Adequate prior screening is defined as three consecutive negative cytology results, or two consecutive negative HPV or co-testing results within 10 years prior to cessation of screening, with the most recent test occurring within 5 years. This patient meets these criteria, as she had two negative co-tests at ages 60 and 64.

Step-by-Step Solution

1
Assess the patient's age and current screening status.
The patient is 66 years old with an intact cervix.
Age determines if the patient has reached the upper age limit for routine cervical cancer screening.
2
Evaluate the patient's prior screening history.
The patient had negative co-testing at ages 60 and 64, meeting the criteria of two consecutive negative co-tests within the past 10 years, with the most recent within 5 years.
Adequate prior screening must be confirmed before discontinuing tests.
3
Determine if the patient is at high risk for cervical cancer.
The patient has no history of cervical dysplasia, cancer, or immunocompromise.
High-risk patients may require continued screening beyond age 65.
4
Apply the appropriate preventive care guideline.
Cessation of screening is indicated.
USPSTF guidelines recommend against screening in women over 65 who meet the cessation criteria.

Key Concept

Cervical cancer screening cessation guidelines
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Topics

Preventive Care and Screening

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