Mortality from cervical cancer is decreasing in countries where aggressive Papanicolaou smear screening programs are in place. However, elderly women are likely to be lifelong nonusers or underusers of Papanicolaou screening, and mortality has not declined for older women. Many studies have noted that nonparticipants in Papanicolaou screening have a 2.7 to four times greater incidence of cervical cancer when they are screened compared with women who have been screened at least once. Gynecological screening was offered to 1542 elderly women in a primary care setting; 75% of the women had not had regular prior screening and 25% had never been screened. Half of these women chose to participate in our screening program. An overall prevalence rate of 13.5 per 1000 abnormal Papanicolaou smears (95% confidence interval, 5.6 to 21.4) was noted in the group. Age, race, prior screening history, and abnormal gynecological symptoms failed to predict the women who would have abnormal Papanicolaou smears. Our results suggest that cervical cancer screening should continue beyond 65 years of age if women have not received regular prior screening.