A new study shows that many women diagnosed with and dying from cervical cancer are older than 65. Depending on a woman’s history of routine screening and results, the recommendation by many medical groups, including the American Cancer Society are that after age 65, screening is no longer needed.
The study, published in Cancer Epidemiology, Biomarkers & Prevention, shares data from a California cancer surveillance program from 2009-2018. That study found that within the participant group:
- 12,000+ women were diagnosed with cervical cancer
- 17% were women age 65+
- 71% of the women age 65+ that were diagnosed with cervical cancer had advanced cancer.
- To compare, 48% of younger women diagnosed with cervical cancer were in the more advanced stages of cancer.
- Late-stage five-year relative survival was lower for women 65 and over (23.2%-36.8%) compared to patients under 65 (41.5%-51.5%). Women 80 years and older had the lowest survival of all age groups.
The findings are surprising, and many wonder why women age 65+ would receive any suggestion to stop screening when there is still potential for them to develop cervical cancer. Providers as well as the lead researcher, Julianne Cooley, state that it does not mean that screening recommendations are wrong.
“We can’t say the guidelines, themselves, are failing women,” said Cooley, of the University of California, Davis, Comprehensive Cancer Center. What medical professionals agree on is that the precursors to stop screening aren’t being followed.
What are the current guidelines?
The American Cancer Society is one medical group that states women can stop screening after age 65 IF:
- They have had routine screenings for the past 10 years
- Those screenings have resulted in normal results
General recommendations (for women age 25-65, including those who have received the HPV vaccine):
- Start screening at age 25
Test options include:
- A “primary” HPV test every five years (preferred method), which can detect types of HPV (human papillomavirus) that cause most cases of cervical cancer from cells that are collected from the cervix.
- A co-test is when you receive both the HPV test and a Pap (Papanicolaou) test.
- Pap test alone. Receive this test every three years.
No matter which option you and your provider choose for your individual health, medical professionals urge that you adhere to the recommended schedule.
The American Cancer Society also states that people who have had a total hysterectomy (removal of the uterus and cervix) should stop screening (such as Pap tests and HPV tests), unless the hysterectomy was done as a treatment for cervical cancer or serious pre-cancer. People who have had a hysterectomy without removal of the cervix (called a supra-cervical hysterectomy) should continue cervical cancer screening according to the
In order for fewer women age 65+ to ensure they don’t stop screening before it is safe for them to do so, they need to be in close communication with their provider to establish whether the screening they have received was adequate.
Debbie Saslow, managing director of cancer control interventions for HPV and gynecological cancers at the American Cancer Society reinforced that regular screening is the best prevention, “Older women who’ve been getting screened as recommended aren’t the ones getting cervical cancer. Most women who get cervical cancer have never been screened in their lives or have only rarely been.” Other research has found that regular screening is one of the best ways to prevent and detect cervical cancers. The other prong of prevention is to receive the HPV vaccine, which helps prevent infection from the human papillomavirus (HPV), which has been found to be the main cause of cervical cancer.
If you’re unsure whether you’re up to date on your screening, speak to your provider.
In my practice far too many women aren’t getting the care they deserve and have ended up with ovarian or uterine issues. If you still have organs the only way they’ll be assessed is through an internal exam. It’s an easy way to detect a problem early, before it becomes life threatening. Especially if your screening has been irregular or non-existent. It’s never too late to start.