Sixty-Six and Asking Whether She Still Needs a Pap: A Well-Woman Visit That Decided When to Stop Cervical Screening and What Screening to Start Instead
[Student Name]
University of Phoenix
NRP/563: Management of Women's Health Issues
Week 2 Assignment
[Instructor Name]
[Date]
The patient is a composite written for a model paper.
Mrs. P., a 66-year-old retired school secretary, comes for her annual well-woman visit and asks, "My friend said I don't need Paps anymore. Is that true for me?" She has been married to the same partner for 40 years, has never smoked and has not had a hysterectomy. She thinks she had an abnormal Pap "a long time ago." This paper describes how we answered her question and completed her preventive care.
The Rule for Stopping
The federal task force advises against continuing cervical screening after 65 when a woman's earlier results were adequate and negative and nothing else puts her at high risk (U.S. Preventive Services Task Force et al., 2018). The American Cancer Society similarly recommends that individuals older than 65 with adequate negative prior screening and no history of high-grade precancer within the past 25 years discontinue screening (Fontham et al., 2020). In practice, adequate means a run of negative results in the decade before 65, three normal Pap tests in a row or two normal co-tests or HPV tests in a row, with the last one recent.
Checking Her Records
The rule depends on records, not memory. I request her results from her previous clinic. She had negative co-tests, cytology plus HPV, at ages 58 and 63. That meets the definition of adequate negative screening in the past 10 years, with the most recent within five years.
The Earlier Abnormal Result
Her records also show that at 41, she had a biopsy showing cervical intraepithelial neoplasia grade 2, treated with a loop excision. Fontham et al. (2020) and the ASCCP risk-based guidelines advise that people treated for high-grade precancer continue surveillance for at least 25 years after treatment, even if this extends beyond age 65 (Perkins et al., 2020). Her treatment was 25 years ago, at 41; she is now 66, so this requirement has just been met, and her subsequent screening has been negative.
Her friend was right for her friend; for Mrs. P., the answer depended on a biopsy 25 years ago.
The Decision
With adequate negative screening in the past 10 years and more than 25 years since treatment for CIN 2, she meets criteria to stop cervical screening. I explain this, and she chooses to stop. I document the basis for the decision so that future clinicians do not restart screening unnecessarily. If she develops abnormal bleeding or other symptoms, evaluation is diagnostic, not screening, and remains necessary.
What Screening Now Matters More
Stopping one screening frees attention for others that her age calls for:
Breast cancer: mammography every one to two years.
Colorectal cancer: her colonoscopy at 60 was normal; the next is due at 70.
Osteoporosis: bone density testing is recommended for women 65 and older; she has never had one, so I order it.
Cardiovascular risk: blood pressure, lipids and diabetes screening are updated.
Hepatitis C: she had one-time testing previously.
Immunizations: she is due for pneumococcal vaccine and the recombinant zoster series, and I recommend an updated COVID-19 and annual influenza vaccine.
Falls and function: I ask about falls and assess gait.
Why Records Matter
Many women cannot recall their screening history accurately, and clinics often lack older records after moves or changes in insurance. When records cannot be found, the guidelines suggest that women over 65 without documentation of adequate screening continue screening until criteria are met. Taking the time to request Mrs. P.'s records turned an uncertain answer into a clear one, and it revealed the prior CIN 2, which changed the reasoning.
HPV and Her Relationship
Mrs. P. asked whether her long monogamous marriage means she never needed screening. I explained that HPV can persist for many years after exposure and that screening decisions are based on results, not on relationship history, although a single long-term partner does lower new exposures. Her prior CIN 2, decades into her marriage, illustrates that point.
Her Bone Density Test
Women 65 and older are recommended for osteoporosis screening. Mrs. P. is small-framed and her mother had a hip fracture, both of which raise her risk. The result will guide whether she needs treatment and how often to repeat the scan.
Mammography Frequency
She asks whether she still needs yearly mammograms. Recommendations vary between every year and every two years for women her age; we discuss her preferences and her family history, which includes no breast cancer, and she chooses every two years.
Other Well-Woman Topics
I ask about vaginal dryness and sexual health, urinary symptoms, mood and sleep. She reports mild vaginal dryness with intercourse, and we discuss vaginal moisturizers and low-dose vaginal estrogen as options.
Sexual Health and Infections
Screening for sexually transmitted infections is not routinely recommended at her age in a long-term monogamous relationship, but I ask whether anything has changed, since risk depends on behavior rather than age.
Mood and Cognition
A brief depression screen is negative. She reports occasional forgetfulness; a quick cognitive screen is normal, and I reassure her while inviting her to raise it again if it worsens.
Aspirin and Statins
She asks whether she should take a daily aspirin like her husband. For women her age without cardiovascular disease, aspirin for primary prevention is not generally recommended because bleeding risk rises with age. Her statin decision will depend on her updated lipid results and calculated risk.
Why Screening Should Stop
Continuing cervical screening in women who meet the criteria offers little benefit, because new cervical cancer is uncommon in older women with adequate negative screening, and it carries harms: discomfort, false-positive results and follow-up procedures that are harder in postmenopausal tissue. Stopping is evidence-based care, not neglect.
Colorectal Screening Beyond 75
Looking ahead, I mention that colorectal screening decisions after 75 depend on health and prior results, so that the topic of stopping screenings will come up again in future visits.
A Note on Symptoms
I remind Mrs. P. that stopping screening does not mean ignoring symptoms: postmenopausal bleeding, unusual discharge or pelvic pain should always be reported and evaluated promptly, whatever her screening status.
Documenting the Decision
The chart now states that cervical screening was discontinued at 66 after two negative co-tests in 10 years and more than 25 years after treatment for CIN 2. Clear documentation prevents another clinician, seeing no recent Pap, from ordering one unnecessarily.
Conclusion
Mrs. P. asked whether she could stop Pap tests. Her records showed two negative co-tests in the past 10 years and treatment for CIN 2 exactly 25 years ago, so she meets USPSTF and American Cancer Society criteria to stop. The visit then focused on the screening her age calls for, including her first bone density test, and on immunizations and sexual health, turning a question about stopping into a plan for what matters now.
References
Fontham, E. T. H., Wolf, A. M. D., Church, T. R., Etzioni, R., Flowers, C. R., Herzig, A., Guerra, C. E., Oeffinger, K. C., Shih, Y.-C. T., Walter, L. C., Kim, J. J., Andrews, K. S., DeSantis, C. E., Fedewa, S. A., Manassaram-Baptiste, D., Saslow, D., Wender, R. C., & Smith, R. A. (2020). Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA: A Cancer Journal for Clinicians, 70(5), 321-346. https://doi.org/10.3322/caac.21628
Perkins, R. B., Guido, R. S., Castle, P. E., Chelmow, D., Einstein, M. H., Garcia, F., Huh, W. K., Kim, J. J., Moscicki, A.-B., Nayar, R., Saraiya, M., Sawaya, G. F., Wentzensen, N., & Schiffman, M. (2020). 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. Journal of Lower Genital Tract Disease, 24(2), 102-131. https://doi.org/10.1097/LGT.0000000000000525
U.S. Preventive Services Task Force, Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., Doubeni, C. A., Epling, J. W., Jr., Kemper, A. R., Kubik, M., Landefeld, C. S., Mangione, C. M., Phipps, M. G., Silverstein, M., Simon, M. A., Tseng, C.-W., & Wong, J. B. (2018). Screening for cervical cancer: US Preventive Services Task Force recommendation statement. JAMA, 320(7), 674-686. https://doi.org/10.1001/jama.2018.10897
How this NRP 563 Week 2 example is structured
The NRP/563 Week 2 work usually addresses the well-woman visit and preventive screening. This paper centers on a decision older women often ask about, stopping cervical screening, and shows how records, criteria and a prior result determine the answer, then completes the rest of her preventive care. Students search this week as NRP 563 Week 2, NRP563 Wk 2 or NRP/563 Wk 2; all three are the same assignment.
NRP/563 Week 2 questions, answered
What does NRP/563 Week 2 usually ask for?
Many sections ask students to plan a well-woman visit, including age-appropriate screening, counseling and immunizations based on current guidelines.
When can women stop cervical cancer screening?
The USPSTF recommends against screening women older than 65 who have had adequate prior screening and are not otherwise at high risk. Adequate screening generally means three consecutive negative cytology results or two consecutive negative co-tests within 10 years, the most recent within 5 years.
Does a prior abnormal result change the stopping age?
Yes. Women with a history of high-grade precancer should continue screening for at least 25 years after treatment, even beyond 65.
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