American Board of Internal Medicine (ABIM) Certification Practice Exam

Under what circumstances should women age 65 and older stop Pap smears?

1. Three consecutive negative cytology results

2. One positive cytology result

3. Annual screening with HPV testing

4. Two consecutive negative cytology results and HPV testing within the last 3 years

The correct answer is: Three consecutive negative cytology results

The correct answer for when women aged 65 and older may stop Pap smears is based on achieving a specific history of adequate screening results. Women in this age group should discontinue Pap smears if they have had three consecutive negative Pap tests within the last ten years. This reflects guidelines that aim to reduce unnecessary testing while ensuring that only those patients who may still be at risk for cervical cancer continue to be screened. The underlying rationale for this guidance is that if a woman has consistently demonstrated negative results over multiple years, her risk for developing cervical cancer significantly decreases, and the benefits of further screening diminish. This decision-making process relies on the idea that a sustained history of negative results suggests that any potential for cervical dysplasia or cancer has been effectively ruled out. In contrast, experiencing one positive cytology result does not provide sufficient evidence to stop screening, as it necessitates further follow-up. Annual testing with HPV is still perhaps appropriate in certain circumstances, but it would not be a basis for ceasing Pap smears. Additionally, the combination of two negative cytology results along with HPV testing within a certain timeframe may not meet the specific guideline for three consecutive negatives across a decade. Thus, the standard for ceasing Pap smears hinges on that established history