Risk factors for the development of cervical carcinoma may be assessed on an ongoing basis and taken into consideration when deciding how often and for how long to screen older women for the development of cervical carcinoma. Individual circumstances such as the patient s life expectancy, ability to undergo treatment if cancer is detected, and ability to cooperate with and tolerate the pap smear procedure may obviate the need for cervical cancer screening. Women who have had a hysterectomy may have a remaining cervix and, if one is present, may be screened under the same criteria outlined above. If no cervical tissue remains, no further pap smear is needed, provided the hysterectomy was performed for benign disease, and risk factors for the development of cervical neoplasia are not present. Cervical sampling is carried out by means of gentle scraping of the ectocervix with a curved spatula, followed by insertion and rotation of an endocervical brush.
More research is needed on pap smear screening in older women.
Potential areas of investigation include more clearly defining high risk subsets of the elderly, estimating the utility of screening residents of long-term institutions, and innovative approaches to enhance the participation of appropriate older persons in screening programs. Change in American Cancer Society Guidelines for detection of cervical cancer. Number 152, March, 1995. In Guide to Clinical Preventive Services. National Institutes of Health Consensus Development Conference Statement on Cervical Cancer.