Cervical Cancer Screening Overuse Continues in Women 65+, Despite Long-Standing Guidelines

Despite long-standing clinical guidelines advising against routine cervical cancer screening in older women, unnecessary testing remains common among women over 65, according to new national findings from healthcare data and analytics leader Motive Medical Intelligence (Motive). The analysis found more than a four-fold difference in screening rates across U.S. states, underscoring persistent variation in clinical practice.

Cervical cancer screening with the Papanicolaou (“Pap”) test, and more recently, DNA-based human papillomavirus (HPV) testing, has dramatically reduced cervical cancer incidence in the U.S. However, continued screening beyond recommended ages offers little benefit for women who have been adequately screened and have no history of cervical disease.

Guidelines from leading organizations, including the U.S. Preventive Services Task Force and the American Cancer Society, recommend discontinuing routine screening after age 65 for women with adequate prior screening and no history of abnormal results. The American College of Obstetricians and Gynecologists similarly advises: “If you are 65 or older, you do not need screening if you have no history of cervical changes and either three negative Pap test results in a row, two negative HPV test results in a row, or two negative co-test [Pap + HPV] results in a row within the past 10 years.”

Analyzing data from more than 100 million patients, Motive found inappropriate screening rates ranged from 5% in North Dakota and 6% in Minnesota to 25% in New York. Several Northeastern and Mid-Atlantic states showed the highest rates, while the Upper Midwest and Mountain West had lower but still clinically significant levels of overuse.

“Unnecessary screening can be harmful. False positive results can lead to unnecessary invasive testing and treatment, which may have side effects and complications,” said Rich Klasco, MD, Motive’s Chief Medical Officer. “As well, the emotional stress resulting from false positive results is an often-overlooked psychological consequence of over-screening.”

Motive’s analysis suggests geographic differences are driven more by local practice patterns, clinician behavior, and health system incentives than patient risk. The findings point to an opportunity for targeted education and quality improvement to reduce low-value care.

“These patterns are not simply academic,” said Julie Scherer, PhD, Motive’s Chief Solutions Officer. “They translate into avoidable procedures, wasted healthcare resources, and patient harm, exactly the outcomes that value-based care models were intended to prevent.”