New findings highlight need to reconsider cervical cancer screening guidelines

Women older than age of 65 should still get screenings

One in five women diagnosed with cervical cancer in the United States will be diagnosed after the age of 65, suggesting that the recommend age to stop cervical cancer screening should be reconsidered, according to researchers who presented today at the Society of Gynecologic Oncology’s 2018 Annual Meeting on Women’s Cancer.

The American Cancer Society, American Society for Clinical Pathology and American Society of Colposcopy and Cervical Pathology currently recommend that cervical screening stop after women turn 65 years of age, as long as they have had adequate screening and are at low risk. The guidelines do not currently address how to stratify risk of cervical cancer in women over the age of 65.

Lead researcher Sarah Dilley, MD, MPH, fellow in gynecologic oncology at The University of Alabama at Birmingham presented findings showing 19.7 percent of cervical cancer cases were diagnosed in women age 65 or older from 2000-2014 according to the Surveillance, Epidemiology and End Results (SEER-18) program database. The database, of the National Cancer Institute, keeps information on cancer incidences and survival rate across the country.

Dr. Dilley also used the National Cancer Database to investigate cervical cancer rates based on age and found that 18.9 percent of cervical cancer cases were diagnosed in women over the age of 65 from 2004-2014.

When stratified by age, 22.9 percent of African American women who are diagnosed with cervical cancer are age 65 or older, compared to 20.5 percent of non-Hispanic white women.

The National Cancer Database (NCDB), sponsored by the American College of Surgeons and the American Cancer Society, collect hospital registry data from more than 1,500 Commission on Cancer (CoC)- accredited facilities.

The data are especially interesting when compared to women diagnosed from ages 20 to 29. Only 5.1 percent of cervical cancer cases were diagnosed from age 20 to 29, while 8 percent were diagnosed from age 70 to 79. “This data point contradicts the misperception that women usually only are diagnosed with cervical cancer at a younger age,” Dr. Dilley said.

“Our data suggest that a considerable proportion of women are diagnosed with cervical cancer after age 65, which suggests that patients are being aged out too soon or not getting screened at all,” Dr. Dilley continued. “Professional societies should consider extending the age screening requirements to improve outcomes for this older population of women.”

While age outcomes need to be addressed with cervical cancer screening, Dr. Dilley said that health disparities are still very much evident with cervical cancer patients.

The results of this study suggest that some women over the age of 65 years may still benefit from screening to prevent age-based disparities in cervical cancer diagnoses and emphasize the importance of informed shared decision-making between patient and her doctor.