Ever since the first organised cervical screening programmes started in Europe more than 40 years ago discussion about the upper age limit for effective screening has been ongoing. The debate is still relevant because mass vaccination of pre-adolescent girls against two or more types of human papillomavirus (HPV) will not affect the incidence of cancer in girls born around the turn of the millennium until 2050-60. In the linked study (doi:10.1136/bmj.b1354), Rebolj and colleagues report that the incidence of cervical cancer is similar in 218 847 women aged 45-54 years and 445 382 women aged 30-44 after their third negative smear.1

Evidence suggests that repeating smear tests in women aged 60-65 whose previous tests have been normal has little, if any, benefit,2 and some researchers have proposed that the age limit should be lowered to 50.3 4 In all European programmes, cervical cancer screening stops at a lower age than breast cancer screening, and in some programmes …