We began combining human papillomavirus (HPV) testing with Pap smears a couple of years ago. Recently, Medicare refused to pay for the HPV screening. I assume that Medicare made the judgment that older women were less likely to get HPV and therefore won’t pay for testing. I have adopted the strategy that if a woman older than 65 on Medicare has had previously normal Pap smears, it is safe not to test for HPV. Is my assumption correct?
—John R. Dykers Jr, MD, Siler City, N.C.

No screening guidelines for cervical cancer, including those of the U.S. Preventive Services Task Force (USPSTF), recommend HPV testing in addition to examining cervical cytology (Pap smear). Currently, the USPSTF states that there is insufficient evidence to recommend for or against HPV testing either as primary screening or in addition to Pap smear screening. Women older than 65 with previously normal Pap smears have an extremely low risk of developing cervical cancer, so it is reasonable to use only a Pap smear in these women. The USPSTF recommends against routine screening for cervical cancer in women older than age 65 if they have had adequate recent screening with normal Pap smears and are not otherwise at high risk for cervical cancer. Other organizations, including the American Cancer Society, have similar recommendations.
—Daniel R. Mishell Jr, MD (103-18)

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