Objective: To study patterns of abnormal cervical cancer screening in women aged >60 years and explore the risk and predictors of cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Methods: This retrospective cohort study examined 1,596 women aged >60 years with abnormal cervical cancer screening results from eight Thai cancer centers. Those who underwent hysterectomy were excluded. Patient characteristics, previous and current cervical cancer screening results, and histopathology data were collected and analyzed. Results: Mean age was 68.2±7.2 years. The abnormal screening results were normal cytology with positive high-risk human papillomavirus (0.9%), atypical squamous cells of undetermined significance (37.7%), low-grade squamous intraepithelial lesion (12%), atypical squamous cell cannot exclude high-grade lesion (11.7%), high-grade squamous intraepithelial lesion (12.7%), atypical glandular cell (20.1%), squamous cell carcinoma (4.3%), and adenocarcinoma (0.7%). Risk of CIN2+ in women with abnormal screening was 17.9% (95% confidence interval [CI]=16.1–19.8); among those with available histopathology, the risk was 28.8% (95% CI=26.1–31.7). Univariable logistic regression showed that age >70 years, sexual activity within 1 year, previous abnormalo screening, previous CIN2+ pathology, presence of symptoms, and high-grade cytology were significant predictors of CIN2+. In the multivariable analysis, lack of previous screening (adjusted odds ratio=4.05;95% CI=1.91–8.60; p<0.001) and high-grade cytology (adjusted odds ratio=7.00; 95% CI=3.34–14.67; p<0.001) were independent predictors of CIN2+. Conclusion Continuing cervical cancer screening in women aged >60 years should be individualized based on their risk factors, particularly for those who have never been screened.