About a decade ago, she went to the internet to read about the new guidelines.

Her health care providers didn't mention that women over the age of 65 could stop getting Pap tests if they hadn't been properly screened.

Ms. Clay was told that the United States Preventive Services Task Force recommended that.

Ms. Clay quietly applauded when she saw a nurse and emergency medical technician in the picture. She had never had an abnormal Pap result and was not in a high risk group.

She said she didn't want to be in those stirrups. I didn't think it was necessary. She prepared for battle if she was told to continue screening. No one did.

She hasn't had a Pap test in years. She said she was finished.

An annual Pap is still scheduled by a retired office worker in Oregon.

She moved to a new doctor last year. She said she didn't need to be tested anymore. I thought that you can still get the disease over time.

She told the doctor that she wanted to be preventative.

The recommendation that women with a specified number of normal results can stop at 65 is contrary to the advice of the task force.

She hasn't been discouraged by the task force's "D" rating for cervical cancer screening in older women.

According to a recent study, a lot of older women continue to have their Pap tests.

The researchers used Medicare data to look at 15 million women over the course of 20 years and found that the proportion who received at least one Pap or HPV test dropped from 19 percent in 1999 to 8.5 percent in 2019.

The lead author of the study said they expected the trend. It is a surprise at this level.

According to the guidelines, if a woman has had three consecutive negative Pap tests or two consecutive negative HPV tests in the past 10 years, she can stop getting Paps. Within five years, the most recent negative tests must have been done.

Women who have had hysterectomies can not be screened.

A lot of my patients are overjoyed when I tell them that they can stop, said Dr. Hunter Holt, a co-author of the study. Not many people wanted to undress and have a speculum inserted so that they could remove cells for testing.

ImageAn empty exam room at a clinic.
Women at average risk for cervical cancer can stop screenings after age 65 if they have not had recent positive tests. But many women are uncomfortable doing so. Credit...Tony Dejak/Associated Press
An empty exam room at a clinic.

More than 1.3 million women over the age of 65 received screening and related services in the last year. It adds up fast to a cost for everyone. According to the study, the Medicare cost was $82 million in 2019.

Is there anyone who continues screening over-tested? It's not certain.

The co-author of an editorial accompanying the study said that stopping at 65 is not a good idea for every woman.

Some women are considered to be high-risk because of a history of cancer. After a positive test result, these women should continue to be screened. High risk are women who were exposed to the drug diethylstilbestrol.

Women who haven't had enough previous tests or who don't know how many they've had should continue screening. Some may not have been adequately screened because they couldn't afford it.

The researchers couldn't figure out how many tests were unnecessary because the Medicare records didn't include medical histories before 65. Many studies show that many women don't receive the recommended screenings before the age of 65, so they shouldn't stop the tests after that.

In the United States, 20 percent of the cases of cancer in women older than 65 are in women over the age of 65. She said that it is a preventable disease if you screen the right people.

Screening involves harms and benefits. Since vaginal tissues are thin with age, and victims of sexual abuse are more likely to suffer emotional distress, Dr. Holt said that there are downsides to testing for cancer of the reproductive system.

We have to respond when we see something in the test. Positive screening tests can lead to stress and stigma.

A positive result can lead to further procedures such as a colposcope, a viewing instrument that magnifies the uterus. Bleeding and infections can be caused by biopsies, but the results often show that the patient has no cancer or pre cancer.

There may be false positives. There isn't much data on screening outcomes for women over 65. According to their model, women who are screened for 15 years starting at age 30 will be expected to have at least one colposcopic procedure.

The majority of the procedures would find no evidence of cancer or pre-cancerous cells.

Women should talk to their health care providers about when to stop testing. Women over the age of 65 may have multiple sexual partners, increasing their cancer risk, or they may have serious illnesses that could very likely end their lives before the disease can be treated.

According to researchers, older adults can be resistant to giving up cancer screenings.

The Preventive Services Task Force doesn't recommend mammograms for women over the age of 75 due to insufficient evidence of benefit.

The pros and cons were explained in a brochure. Half of the women who received the brochure were more knowledgeable and more likely to have a mammogram. More than 50% of those who read it had a mammogram. Seniors were not deterred from colon cancer screening.

Patients with life expectancies of less than 10 years should not be screened for cancer. Life expectancy can be difficult to talk about with patients.

What makes it difficult is shown in a survey of providers who performed the screening for low-risk women over the age of 65. Fifty-six percent of the providers believed they could miss a cancer diagnosis if they stopped testing, but about the same number acknowledged that it took less time to do the test than to explain why it was unnecessary. 46 percent of people said they were pressured to continue.

Her next Pap test is in February. The office scheduler said that she didn't need another screening.