Mary C. White, ScD, Chief, Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control
Centers for Disease Control and Prevention (NAACCR Member)
For women between the ages of 21 to 65, Pap testing every three years, or Pap testing with HPV co-testing every five years, can prevent cervical cancer cases and deaths. Current USPSTF recommendations state that women 65 and older (and not otherwise at special risk) can skip Pap tests, but only if they have had three consecutive negative Pap screening tests or two consecutive negative co-tests over the past 10 years, with the most recent done within the past five years. We used combined data from CDC’s NPCR and NCI’s SEER cancer registry programs to examine how cervical cancer risk changes with age, after adjusting population denominators to reflect the estimated proportion of women who have had a hysterectomy by age. We also examined data from CDC’s National Health Interview Survey to determine the proportion of women who either had never been tested or had not been tested in the last 5 years. We concluded that an older woman who has not had her cervix surgically removed has the same or higher risk of developing cervical cancer than a younger woman, consistent with an earlier report using only SEER data. A substantial number of women near the “stopping” age for screening have not been screened for many years. The take-home message is that cervical cancer is not just a young woman’s disease. Women who have not had a hysterectomy remain at risk for cervical cancer as they grow older. It’s important to reach out to women who have not had a hysterectomy and have not been screened for many years, including many older women, to prevent cases of – and deaths from – cervical cancer. Women over 65 who have not been screened for many years still may need to be screened.
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American Journal of Preventative Medicine
Abstract
Introduction: Leading professional organizations recommend cervical cancer screening for average-risk women aged 21-65 years. For average-risk women aged >65 years, routine screening may be discontinued if “adequate” screening with negative results is documented. Screening is recommended after age 65 years for women who do not meet adequate prior screening criteria or are at special risk.
Methods: Authors examined the most recent cervical cancer incidence data from two federal cancer surveillance programs for all women by age and race, corrected for hysterectomy status. The 2013 and 2015 National Health Interview Surveys were analyzed in 2016 to examine the proportion of women aged 41-70 years without a hysterectomy who reported that they never had a Pap test or that their most recent Pap test was >5 years ago (not recently screened).
Results: The incidence rate for cervical cancer among older women, corrected for hysterectomy status, did not decline until age ≥85 years. The proportion not recently screened increased with age, from 12.1% for women aged 41-45 years to 18.4% for women aged 61-65 years.
Conclusions: Even among women within the recommended age range for routine screening, many are not up to date, and a substantial number of women approach the “stopping” age for cervical cancer screening without an adequate prior screening history. Efforts are needed to reach women who have not been adequately screened, including women aged >65 years, to prevent invasive cervical cancer cases and deaths among older women.
The opinions expressed in this article are those of the authors and may not represent the official positions of NAACCR.
