Cervical cancer screening may be inadequate in older women
CDC researchers found that more older women than younger women reported not having been screened recently for cervical cancer, and 5.1% of patients ages 66 to 70 years reported that they had never been screened.
Many women nearing the recommended age to stop cervical cancer screening may not have had a recent screening test, according to a new study.
Professional societies currently recommend that routine screening for cervical cancer be discontinued in average-risk women who are older than age 65 years and who have been screened adequately previously with negative results. CDC researchers used 2013 data from its National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program to calculate cervical cancer incidence, corrected by hysterectomy status, according to age and race. In addition, they used data from the 2013 and 2015 National Health Interview Surveys to determine the proportion of women between the ages of 41 and 70 years who had not had a hysterectomy and who reported that they had never had a Pap test or that their most recent test was performed more than five years ago. The study results were published online May 1 by the American Journal of Preventive Medicine.
The researchers found that incidence rates for cervical cancer, corrected for hysterectomy, increased with age until approximately age 70 years and declined after age 85 years. The absolute magnitude of the difference between uncorrected and corrected rates of cervical cancer incidence increased with age and was larger among black women than among white women, the researchers found. More older women than younger women reported not having been screened recently (24% of those 66 to 70 years of age, 18.4% of those 61 to 65 years of age, and 12% of those 41 to 45 years of age). A total of 5.1% (95% CI, 3.7% to 6.8%) of patients ages 66 to 70 years reported that they had never been screened for cervical cancer.
The authors noted that data on screening were based on self-report and that hysterectomy status could not be confirmed, in addition to other limitations. However, they concluded that based on these national data, many women reach age 65 without being up to date on cervical cancer screening and some have never been screened at all. “A recommended upper age limit for routine screening may lead women and providers to assume that cervical cancer is a younger woman's disease,” the authors wrote. They suggested that early discontinuation of routine screening could increase incidence of preventable cases of invasive cervical cancer and deaths and noted that both catch-up screening and first-time screening may be necessary in women older than age 65.
“In the short term, efforts could be undertaken to clarify misperceptions about the risk of cervical cancer among older women and providers,” the authors wrote. “Messages about a ‘stopping age’ should emphasize the recommendation for an adequate screening history of previous negative tests before screening is discontinued, not just chronologic age.” They also noted that the current upper screening age may need to be reconsidered, due to high rates of cervical cancer in older women, longer life expectancy, and differences in HPV exposure by birth year.