Women should not forego cervical cancer screening after they turn 65, says a cautionary new study that disputes prevailing medical guidelines.
Appearing in the American Journal of Preventive Medicine, the new study found that rates of cervical cancer remain at the same level until the age of 85, after which disease incidence begins to drop sharply.
However, current guidelines recommend that women can do away with routine screening after the age of 65 if “adequate” screening has previously ruled out cancer, say the study authors.
The problem with the current guidelines is that many women do not have enough of a documented history to rule out continued screening, yet many do anyway.
“An older woman who has not had her cervix surgically removed has the same or even higher risk of developing cervical cancer compared to a younger woman,” said Dr. Mary C. White, Chief of the Epidemiology and Applied Research Branch in the Division of Cancer Prevention and Control with the Centers for Disease Control and Prevention (CDC).
“Women who have not had a hysterectomy need to continue to be screened until age 65, and possibly later if they have not been screened for many years or are at special risk, consistent with current U.S. Preventive Services Task Force recommendations,” advised White.
The Numbers Add Up
The study assessed cancer rates among thousands of women between the ages of 41 and 70 and found that 20 percent of cervical cancer cases occurred in women over the age of 65. The researchers also discovered that about one-third of deaths from cervical cancer were among women over 65.
Despite the consistent rates, many women had stopped undergoing regular screenings, with the no-screening numbers rising proportionate with age. About 12 percent of women between the ages of 41 and 45 had no screening history, and that number jumped to more than 18 percent among women aged 61 to 65 years.
“A recommended upper age limit for routine screening may lead women and providers to assume that cervical cancer is a younger women’s disease,” said White.
“After adjustment for hysterectomy, some of the highest cervical cancer incidence rates occur among women older than 65 years, with notably higher rates among older black women. Premature discontinuation of routine screening among women in the years before age 65 could contribute to preventable cases of invasive cervical cancer and deaths,” added White.
In a separate informational page, the American Cancer Society warns that “many older women do not realize the risk of developing cervical cancer is still present as they age.”
Medical societies recommend that women get tested every three years starting at age 21. Some guidance suggests women can safely move testing to once every five years depending on their risk factors after the age of 30.
The new study may lead to a change in official guidelines, suggest the researchers.
“In the short term, efforts could be undertaken to clarify misperceptions about the risk of cervical cancer among older women and providers,” said White. “Messages about a ‘stopping age’ need to emphasize the recommendation for an adequate screening history of previous negative tests before screening is discontinued, not just chronologic age.”