Choosing Wisely:

Don’t perform screening for cervical cancer in low-risk women aged 65 years or older and in women who have had a total hysterectomy for benign disease.

Rationale and Comments: Health care professionals should not perform cervical cancer screening in women who have had a hysterectomy that removed their cervix and do not have a history of high-grade precancerous lesions or cervical cancer. Screening provides no benefits to these patients and may subject them to potential risks from false-positive results, including physical (e.g., vaginal bleeding from biopsies) or psychological (e.g., anxiety). In addition, cervical cancer screening should not be performed in women over the age of 65 that are at low risk for cervical cancer and have had negative results from prior screenings. Health care professionals should make this decision on a case-by-case basis, but once a patient stops receiving screenings, in general, they should not restart screenings. Screening for women in this population provides little to no benefit because the incidence and prevalence of cervical disease declines for women starting at age 40–50 years.
Sponsoring Organizations:
  • American College of Preventive Medicine
  • Sources:
  • U.S. Preventive Services Task Force
  • Disciplines:
  • Gynecologic
  • Preventive Medicine
  • Oncologic
  • References: • Moyer; U.S. Preventive Services Task Force. Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;156(12):880-91, W312.
    • Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, Garcia FA, Moriarty AT, Waxman AG, Wilbur DC, Wentzensen N, Downs LS Jr, Spitzer M, Moscicki AB, Franco EL, Stoler MH, Schiffman M, Castle PE, Myers ER; ACS-ASCCP-ASCP Cervical Cancer Guideline Committee. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin. 2012;62(3):147-72.

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