Catch-Up HPV Screenings Help Detect Cancer in Women Over 65

Kelly Ragan

July 07, 2023

A catch-up screening test for human papillomavirus (HPV) may improve cancer prevention and detection in women older than 65 years, according to a new study.

The findings, published on July 6 in PLOS Medicine , included women between ages 65 and 69 years in Denmark who had no record of cervical cancer screening or an HPV test in the previous 5 years. 

"It may be valuable to get women above the current screening age to get this one-time catch-up HPV test if they haven't had one before," said Mette Tranberg, PhD, a cancer epidemiologist and researcher at Randers Regional Hospital in Denmark and lead author of the study. "That is valuable knowledge for healthcare providers and policy makers." 

Cervical cancer in the United States is most often diagnosed in women aged 35-44 years, according to the American Cancer Society, with the average age at diagnosis of 50 years. The cancer rarely occurs in women who have undergone regular screenings.

Though current guidelines recommend that clinicians stop screening women for cervical cancer at age 65 years if their previous screening results have been normal, Tranberg said that many women do not get screened as they get closer to age 65 years. 

A study from researchers at the University of California, Davis, found several factors contribute to older women not receiving adequate screening. Some women may think that they no longer need Pap smears after going through menopause, or they might have received a hysterectomy and think that they no longer require screening. And although Pap tests have built-in HPV screenings, these tend to be less accurate in postmenopausal women.

But women older than 65 years account for about 20% of new cervical cancer cases.

According to the Centers for Disease Control and Prevention, until women reach age 80 years, they are as likely to get cervical cancer as are younger women. Jack Cuzick, PhD, professor of epidemiology at Queen Mary University of London, said that the new data should inform patient care and public health efforts.

"People often don't realize HPV can last even if people haven't been sexually active," Cuzick said. "Even if somebody is nearing 70, it's probably still worth getting an exit test."

The Intervention Group

Study participants were assigned to two groups, one of which was invited to participate in a free HPV screening, either with their general practitioner or by ordering a vaginal self-sampling kit. The control group received standard care, which in Denmark, includes having the opportunity to undergo routine cervical cytology. 

Tranberg and her colleagues found that among women in the intervention group, 62.2% were screened within 1 year. Among the control group, 2.2% had a Pap test. The rate of diagnosed cervical intraepithelial neoplasia grade 2 or worse was 3.9 cases per 1000 eligible women in the intervention group and 0.3 cases per 1000 eligible women in the control group (P < .001).

The study also found that women who had been insufficiently screened between ages 50 and 64 years had a higher prevalence of HPV, with more grade 2 cervical intraepithelial neoplasia lesions or worse, than did those who were sufficiently screened.

High-risk HPV tests are replacing the Pap smear as the primary cervical cancer screening test due to superior sensitivity, according to Tranberg. Though Pap smears detect abnormal cells on the cervix that can lead to cervical cancer, HPV tests specifically look for certain high-risk types of HPV on the cervix. 

In the United States, patient histories of screenings, diagnosis, and treatment of HPV are often unavailable because electronic health records between health systems are often not linked, according to Cosette Wheeler, PhD, professor at the University of New Mexico Comprehensive Cancer Center, in Albuquerque, and founding director of the New Mexico HPV Pap Registry. Clinicians may not know whether a patient needs a screening. 

HPV tests usually have a high threshold of detection in an effort to produce fewer false positives, according to Wheeler, who was not involved in the latest study. But fewer false positives means that the test could produce more false negatives. Older women could benefit from more sensitive screening, such as the high-risk test that the Danish researchers used, according to Wheeler. 

Tranberg said that she was surprised and pleased by the high percentage of women who accepted the screening tests in the intervention group, especially those who received at-home tests and followed up with a clinician. 

"Female life expectancy is really increasing and therefore the number of cervical cancers in women over the age of 65 is expected to rise," Tranberg said. "That's a big reason to rethink whether or not we should do something for these older women." 

The HPV test kits in the intervention region were provided by Roche Diagnostics. According to the contract between Roche and Randers Regional Hospital, Roche had no influence on the scientific process and no editorial rights pertaining to this manuscript.

Kelly Ragan is a journalist living in Colorado.

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