Background: To explore the important of the opportunistic cervical cancer screening for elderly women without standardized screening and the best opportunistic screening strategy. Methods: The participants were elderly women over the age of 65 without being undergone standardized cervical cancer screening from June 2017 to June 2021. All participants were undergone an opportunistic cervical cancer screening. High-risk HPV distribution was analyzed, and we would analysis the accuracy of different screening methods (only cytology, only HPV, HPV +cytology triage, and non-HPV 16/18 +cytology triage or HPV 16/18) for CINII+. Results: A total of 848 elderly women with high-risk HPV infection were included. There were 325 (38.3%) CINII+ patients and 145 (17.1%) invasive cancer patients. The top five HPV subtypes are HPV16, HPV52, HPV58, HPV53 and HPV56, and the infection rates are 31.4%, 21.9%, 19.7%, 11.6%, and 11.6%, respectively. The area under the ROC curve of five screening strategies was 0.715(0.681, 0.750) (ASCUS+), 0.498(0.458, 0.538), 0.623(0.584, 0.663), 0.714(0.680, 0.748) (ASCUS+), and 0.698(0.664, 0.733) (ASCUS+). Conclusions: Elderly women without being undergone standardized cervical cancer screening should be given a chance to be screened for cervical cancer, and the standardized screening program is suitable for elderly women.