SACRAMENTO — Nearly one in five cervical cancer diagnoses were in women 65 years and older, warns a recent study. Most of the diagnosed cases involved late-stage cervical cancer, a result that goes against current health guidelines that advise women to stop screening by this age.
In all, about 71% of women 65 years and older had a diagnosis of late-stage cervical cancer compared to 48% of younger women. The results suggest a need to revise existing guidelines to catch cervical cancer earlier, when it’s more treatable.
“Our findings highlight the need to better understand how current screening guidelines might be failing women 65 and over,” says lead author Julianne Cooley, a senior statistician at the University of California, Davis, in a statement.
Current screening guidelines recommend discontinuing tests for senior women who have had a history of normal Pap and/or Human Papillomavirus (HPV) tests. “We need to focus on determining the past screening history of older women as well as lapses in follow-up care. We must utilize non-invasive testing approaches for women nearing age 65 or those who need to catch up on their cervical cancer screenings,” Cooley says.
One of the issues with detecting cancer after it has already spread to other parts of the body is that it lowers the chance of beating it. Senior women had a lower five-year survival rate when diagnosed with late-stage cervical cancer than people under 65. Women over 80 fared the worse with the lowest survival chances of all age groups.
The study gathered women’s health data from a cancer surveillance system in California. The database had information on cancer incidence, patient demographic, diagnostic, and treatment information as far back as 1988. The study authors were able to identify women 21 years and older diagnosed with a first primary cervical cancer from 2009-2018, the most 10 most recent set of complete data available.
Results showed some interesting associations. Women 65 years and older were more likely to have a late-stage disease if they showed other health comorbidities. Older Latinas were less likely than non-Hispanic white women to receive a diagnosis. “Interestingly, prior studies of younger women have found increased late-stage cervical cancer diagnoses among young Hispanic/Latina and Black women,” Cooley adds.
Another issue potentially contributing to rising cases among older women is not following screening guidelines when they were younger. About 23.2% of adult women in the U.S. are not getting their annual tests, and this may partly be due to not having the financial means to see a doctor or afford copayments or deductibles.
“Scheduled screenings may also decrease as women approach 65, increasing the likelihood that women have not been adequately screened prior to the upper age cutoff,” explains Frances Maguire, a senior epidemiologist at UC Davis and co-author of the study.
There are other factors behind not receiving adequate screening while growing up. People with a supracervical hysterectomy may mistakenly believe they no longer have to continue screenings, but this surgical procedure leaves the cervix intact. Women may also feel uncomfortable or not have the time to undergo a pap smear test. Even when a pap smear test is conducted, they are less accurate in detecting cancer that forms in the glands in postmenopausal women. Finally, older women may not have had an HPV test as it only became available in 2003. Almost all cervical cancer cases are HPV-related.
The study is published in Cancer Epidemiology, Biomarkers & Prevention.