A UC Davis Comprehensive Cancer Center study reports an alarming number of California women 65 and older are facing late-stage cervical cancer diagnoses and dying from the disease. This is despite guidelines that 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, MS, said. “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.”
The ﬁndings from the study, published in Cancer Epidemiology, Biomarkers & Prevention, showed nearly one in ﬁve new cervical cancers diagnosed from 2009-2018 were in women 65 and older. More of these women (71%) presented with late-stage disease than 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.
“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, PhD, MS, a professor in the UC Davis Division of Hematology and Oncology.
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 from 2009-2018, the 10 most recent years that complete data was available.
Among women 65 and older, those who had comorbidities or were older were more likely to be diagnosed with late-stage disease.
“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.”
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. 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.
Previous studies have shown that 23.2% of women in the US who are over 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.
Additional factors may contribute to older women not receiving adequate screening:
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More Women 65 and Older Dying From Cervical Cancer. Appl Rad Oncol.