Cervical cancer remains an important cause of morbidity and mortality in older women. The cancer screening by means of Papanicolaou (Pap) smear testing has been shown to improve early detection. One quarter of new cases of invasive cervical cancer occur in women age 65 and older, yet only 52% of this population has had cervical cytology within the past 3 years, and approximately 25% of elderly women have never been screened. Other populations found to be at risk for underutilization of screening include the uninsured, the poor, and ethnic minorities, especially Hispanics and elderly Blacks. In this study, we examined the prevalence of abnormal Pap smears in various primary care settings in the New York City borough of Queens. The majority of abnormal Pap smears were found in the 65-70 year age group. This group also had the most advanced lesions. The 76-80 year age group had the lowest rate: 13.4 per 1000. The highest abnormal Pap smear rate was in the >86 year age group: 85.7 per 1000. However, none were high-grade lesions. Overall, the rate of abnormal Pap smears was 31.5/1000 for all patients > age 65. This study of Pap smears in a multi-ethnic sample of elderly urban women found the prevalence of abnormal smears to be higher than in prior studies. The ramifications of this may be that Pap smear screening should continue beyond the age of 65, especially if the patient has not had negative screening results in the past. In addition, the alarming rate of abnormal Pap smears in the Black and "Other" populations in this study reinforces the need for culturally appropriate health screening measures for these patients.