Cervical cancer is preventable and curable if treated early. The Pap test, also called the Pap smear, can identify abnormal cell changes in the cervix (the lower, narrow end of the uterus) that may occur because of cancer or before cancer develops. Women are considered to be at high risk for cervical cancer if they:

• Engaged in sexual activity before the age of 16;
• Had multiple sexual partners (more than 5 in a lifetime);
• Have a history of a sexually transmitted disease (including the human papillomavirus and/or HIV infection);
• Had fewer than 3 negative Pap tests within the previous 7 years

The U.S. Preventive Services Task Force recommends against routinely screening women older than age 65 for cervical cancer if they have had adequate recent screening with normal Pap smears and are not otherwise at high risk for cervical cancer. This is because multiple recent studies have shown that the risk of cervical cancer peaks during reproductive years and decreases with age. A history of normal Pap tests further reduces risk. If screening recommendations are not modified with age, then older women are disproportionately likely to have false-positive diagnoses.

While it is difficult to define "adequate recent screening," the American Cancer Society recommends that older women who have had 3 or more documented, consecutive, technically satisfactory normal or negative Pap tests, and who have had no abnormal or positive Pap tests within the past 10 years, can safely stop screening. Screening is recommended for older women who have not been previously screened, when information from previous screening is unavailable, or when screening is unlikely to have occurred in the past (e.g., women from countries without screening programs).

What Medicare covers:

Medicare covers 1 Pap test and pelvic exam every year for women who:

• Are of childbearing age and who have had an examination that indicated the presence of cervical or vaginal cancer or other abnormalities during any of the preceding 3 years;
• Are considered high risk (as described previously) for developing cervical or vaginal cancer.

Medicare covers 1 Pap test and pelvic exam every 2 years for women who are at low risk for cervical cancer.

A clinical breast exam is included as part of the pelvic screening benefit. The beneficiary pays a 20% copayment or coinsurance for the Pap test collection and pelvic and breast exams, but does not have to meet the yearly Part B deductible. The beneficiary pays nothing for the Pap laboratory test.
Other helpful information:

While Medicare covers 1 Pap test and pelvic exam every 2 years for women who are at low risk for cervical cancer, women might want to discuss their need for this test with their health care provider given recent clinical practice guidelines suggesting it is not needed and could lead to false positive diagnoses. Health care providers should consider these clinical practice guidelines in making decisions regarding cervical cancer screening for their patients ages 65 and older who have had adequate recent screening.

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Related Links Inside CMS
Medicare.gov "Stay Healthy" Cervical Cancer Information Prevention - General Information
Related Links Outside CMS
U.S. Preventive Services Task Force Cervical Cancer Screening Recommendations NCI--Cervical Cancer Information CDC--Cervical Cancer Information American Cancer Society--Learn About Cervical Cancer

Page Last Modified: 06/30/2008 7:18:10 AM
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