摘要Objective Current guidelines recommend discontinuing screening for women≥65 years with a history of normal primary cervical cancer screening results.However,the necessity of continued screening in this population remains debated.This study aims to evaluate the importance of cervical cancer screening in women aged≥65.Methods This retrospective study analysed cervical cancer screening data from Shenzhen(2017-2023)to assess the distribution of high-risk human papillomavirus(hr-HPV),the prevalence of cervical intraepithelial neoplasia grade 2 or worse(CIN2+)and the association between hr-HPV and CIN2+risk in women aged≥65 and＜65,comparing the two age groups.Results A total of 2152 766 records were analysed,including 17 420 women aged≥65(0.81％).The hr-HPV prevalence in women aged≥65 was 13.67％,with a CIN2+detection rate of 3.33‰ and a cancer rate of 0.92‰,compared with 8.08％,1.55‰ and 0.1 ‰,respectively,in women aged＜65(all p＜0.001).Single,double and triple hr-HPV infections were found in 10.56％(n=1839),2.32％(n=404)and 0.57％(n=99)of cases in women aged≥65,with CIN2+detection rates of 2.01％,2.73％and 4.04％,respectively,all exceeding those aged＜65(all p＜0.001).The most common genotypes in older women were HPV52,HPV16,HPV58,HPV56 and HPV68,with HPV18,HPV16 and HPV33 being major causes of CIN2+,along with frequent double infections such as HPV52/58,HPV16/52 and HPV52/56,while CIN2+was predominantly associated with HPV33/39,HPV35/31 and HPV18/39,which differ from those in younger women.A dose-response relationship between hr-HPV infections and CIN2+risk was observed in women aged≥65(p for trend＜0.001).ORs for CIN2+were 55.86(95％CI 21.81 to 143.07),65.95(95％CI 22.63 to 192.18)and 85.45(95％CI 24.15 to 302.35)for single,double and triple or more hr-HPV infections,respectively,but the ORs were lower in women aged＜65.Conclusions Women aged≥65 bear a higher cervical cancer burden than those＜65.Moreover,hr-HPV infections and their pathogenicity exhibit unique patterns in this older group.Therefore,targeted screening and intervention are essential for women aged≥65.Tailored strategies should be implemented based on national contexts.