A new study conducted by UC Davis Comprehensive Cancer Center researchers shows that an alarming number of California women age 65 and older are facing late-stage cervical cancer diagnoses and dying from the disease. This is because federal guidelines recommend most women stop screening for cervical cancer at this age.
“Our findings highlight the need to better understand how current screening guidelines might be failing women 65 and over,” the study’s lead author, UC Davis senior statistician Julianne Cooley, said. “We need to focus on determining the 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.”
The findings from the study, published in Cancer Epidemiology, Biomarkers and Prevention on January 9, 2023, showed that nearly one in five new cervical cancers diagnosed from 2009 to 2018 were in women 65 and older. More of these women (71%) presented with late-stage disease than did younger women (48%), with the number of late-stage diagnoses increasing up to age 79. 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.d
"Our study found worsening five-year relative survival from cervical cancer with each increasing age category for both early- and late-stage diagnoses,” said co-author Theresa Keegan, a professor in the UC Davis Department of Internal Medicine’s Division of Hematology and Oncology.
California Cancer Registry Provided Crucial Data
The study utilized a large set of population-based data from the California Cancer Registry. This state-mandated cancer surveillance system has collected cancer incidence and patient demographic, diagnostic, and treatment information since 1988. The data was used to identify all women 21 years and older who were diagnosed with a first primary cervical cancer in California between 2009 and 2018, the 10 most recent years for which complete data was available.
In the 65-plus group, late-stage disease was most prevalent among those of advanced age and those who had comorbidities.
"Interestingly, prior studies of younger women have found increased late-stage cervical cancer diagnoses among young Hispanic/Latina and Black women," Cooley said. "Our study did not observe these associations and instead found that older Hispanic/Latina women were less likely than non-Hispanic white women to be diagnosed late-stage."
Current Screening Guidelines
Following the introduction and widespread adoption of the Papanicolaou (Pap) smear test in the 1940s, cervical cancer incidence and mortality have fallen significantly. However, incidence rates have plateaued since 2012, and rates of invasive cervical cancer have actually increased in recent decades.
Through adequate screening and follow-up, cervical cancer can be prevented or detected at an early stage, which leads to excellent survival prognoses. However, current guidelines recommend discontinuing screening for women 65 or older who have had a history of normal Pap and/or human papillomavirus (HPV) tests, potentially leaving this age group vulnerable.
Lack of Adherence to Screening
Previous studies have shown that 23.2% of women in the U.S. over age 18 are not up to date on recommended cervical cancer screening. Disadvantaged women, such as those who are uninsured or poor, are the least likely to report being up to date with cervical cancer screening.
"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," co-author and senior epidemiologist Frances Maguire said.
Failure of older women to receive adequate screening may also be attributable to additional factors:
- Specific type of hysterectomy. Women who have undergone a supracervical hysterectomy, which leaves the cervix intact, may not realize they need to continue screening for cervical cancer.
- Discomfort. Women may tire of Pap smears due to embarrassment and the intrusiveness of a speculum-based exam.
- Diminished Pap test detection of adenocarcinoma. The screening may not be as accurate in post-menopausal women in detecting adenocarcinoma, which has been increasing in incidence (as compared to squamous cell carcinoma).
- Deficiency in testing for HPV. Women in the older age group may not have received HPV testing, now the gold standard of cervical cancer screening, which wasn’t widely available until 2003. The Centers for Disease Control reports that almost all cases of cervical cancer are HPV-related.
ACKNOWLEDGMENTS
Other authors of the study include Cyllene R. Morris, Arti Parikh-Patel, Renata Abrahão and Hui A. Chen
