Should Routine Cervical Screening Extend Past Age 65?

Roxanne Nelson, BSN, RN

March 29, 2018

Current guidelines recommend that routine cervical cancer screening should end at age 65 years, but new research suggests that there may be an advantage to screening past that cutoff point.

Findings culled from two major US databases, which were presented at the Society of Gynecologic Oncology (SGO) Annual Meeting on Women's Cancer, show that among women diagnosed with cervical cancer, 1 in 5 are aged 65 years or older. Conversely, only 1 in 20 are aged 20 to 29 years.

The current guidelines, which call for cessation of screening at age 65, are based on theoretical modeling that uses real data, said lead author Sarah Dilley, MD, MPH, fellow in gynecologic oncology at the University of Alabama at Birmingham.

"It looks at how much screening is needed to catch cases of cervical cancer and the number of colonoscopies that need to be performed to catch a case," she said. "They did a lot of iterations and combinations and reached the most appropriate conclusion that cervical cancer is not as common in women 65 years and older as it is in earlier age groups.

"The number of unnecessary procedures would outweigh the benefit, particularly in patients who had adequate screening up to this point," Dilley told Medscape Medical News.

In their latest set of guidelines, the US Preventive Services Task Force continues to give a thumbs down to screening in women older than 65 years who have undergone adequate prior screening and are not at high risk for cervical cancer.

The American Cancer Society, the American Society for Clinical Pathology, and the American Society of Colposcopy and Cervical Pathology have similar recommendations, although their current guidelines do not address how to stratify risk for cervical cancer in women older than 65.

Dilley emphasized that an important caveat to their new data is that a large proportion of women who are diagnosed with cervical cancer, whether they are older than 65 years or not, have never been screened. "The most important aspect is getting women in to be screened," she said. "There may be a lot more challenges for women who have never been screened at all."

Although age outcomes need to be addressed, she added, health disparities are still very much evident when it comes to cervical cancer screening.

Large Proportion Diagnosed at 65 and Older

In this study, Dilley and colleagues examined racial and age-related differences in cervical cancer incidence and assessed the potential benefits of cervical cancer screening in women older than 65 years. They used the Surveillance, Epidemiology and End Results–18 database and the National Cancer Data Base (NCDB) to determine the incidence of cervical cancer and to identify descriptive statistics and rates of cervical cancer.

Overall, the rates of cervical cancer cases have decreased over time, but 19.7% of cervical cancer cases were diagnosed in women aged 65 years or older from 2000 to 2014. This proportion, they note, did not change significantly over time.

When the data were stratified by race, non-Hispanic black women were more likely than members of other racial/ethnic groups to be diagnosed after age 65 years (22.9%; P < .001).

In the NCDB, the authors also found that 18.9% of cervical cancer cases were diagnosed in women older than 65 years from 2004 to 2014. Conversely, only 5.1% of cases were diagnosed in women aged 20 to 29 years; 8% of cases were in women aged 70 to 79 years.

The results of this study suggest that some women older than 65 years may still benefit from screening. "This is more than just being about an age cutoff," said Dilley. "We need to make sure that women who are at the highest risk are getting screened."

She noted that they are not advocating that the guidelines be changed right now, but this topic needs additional discussion, because patients may be "aged out" too soon or may not be getting screened at all. "Screening may need a more tailored approach," Dilley added.

Dr Dilley has disclosed no relevant financial relationships.

SGO Annual Meeting on Women's Cancer. Abstract 55, presented March 27, 2018.

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