Toolkit for engaging Under-screened and Never-screened women in the National Cervical Screening Program

Older women

Page last updated: 20 November 2019 (this page is generated automatically and reflects updates to other content within the website)

Older woman may still be at risk of cervical cancer. Although not necessarily under-screened, some older woman may face particular barriers to participating in cervical screening. It may be more difficult for a practitioner to collect a cervical screening sample as the transformation zone moves higher up the vaginal canal as women age. Post-menopausal women may be reluctant to have a Cervical Screening Test as changes to oestrogen levels can cause vaginal atrophy and dryness, which can make the procedure uncomfortable .

Woman aged between 70-74 years of age can safely exit the National Cervical Screening Program if their last Cervical Screening Test indicates oncogenic HPV has not been detected, as they have a low risk of developing cervical cancer.

Woman aged 75 years or older who have never had a Cervical Screening Test or has not had one in the previous five years, may request a Cervical Screening Test and be screened.

Barriers to screening

In addition to the general barriers women may face in participating in cervical screening, the following barriers have been identified as common for older women.

Barriers to cervical screening for Older women
  • Pain and/or discomfort associated with speculum insertion.
  • Misconception that women who have been in a monogamous relationship for many years do not require cervical screening.
  • Misconception that if you have gotten to this age and never had a screen that there is no need to have one now
  • Misconception that women who are no-longer sexually active do not require cervical screening.
  • Misconception that women who have had a hysterectomy do not require cervical screening.

Engagement strategies

The following strategies may be effective in engaging older women in cervical screening.

Strategy

Detail

Explain that HPV may lay dormant

It is important to convey to older women that HPV is common and may lay dormant for many years, even decades.
Reinforce that no matter how long it has been since a woman was last sexually active, cervical screening is still important to help prevent cervical cancer.

Determine type and reason for hysterectomies

Women who have had a hysterectomy should discuss whether vaginal screening is required with their healthcare provider. The answer will depend on the type of hysterectomy performed (i.e. whether the woman still has a cervix) and the reasons why it was needed.

Making the Cervical Screening Test more comfortable

With a loss of oestrogen after menopause there is a natural decline in vaginal lubrication and the vaginal walls can become thinner and dryer, contributing to pain or discomfort during vaginal examinations.
Discuss cervical screening and determine whether your patient finds the Cervical Screening Test painful.
A short-course of vaginal oestrogen cream can be effective in preparing the vagina temporarily for a more comfortable Cervical Screening Test as it reduces vaginal atrophy and dryness.

Consumer resources

5. – Consumer resources – includes a range of downloadable resources which can support conversations about cervical screening