The present study was designed to determine the Pap screening histories of 261 women, ages 20 through 69 years, who were diagnosed with an invasive carcinoma of the uterine cervix. Women who were residents of New York State, exclusive of New York City, and who received a diagnosis between July 1983 and September 1985, were selected for this study. Fifty-four percent of the patients had not received at least one Pap test within three years prior to diagnosis. Women who had not received a prior Pap smear tended to be older, less sexually active, less well educated, and to have more extensive disease at the time of diagnosis than women who had received cytologic examinations. The present study results, coupled to findings of previous reports, demonstrate the need for an intensified effort to insure that all women have access to quality Pap screening services. Particular emphasis needs to be placed on reaching older women who are less likely than younger ones to receive periodic Pap screening. Physicians need to routinely offer older patients who present with nongynecologic conditions the opportunity of receiving cytologic testing.