Newswise — A new study conducted by UC Davis Comprehensive Cancer Center researchers shows an alarming number of California women age 65 and older who are facing late-stage cervical cancer and dying from the disease. This is despite guidelines recommending that most women stop cervical cancer screening at this age.
“Our findings highlight the need to better understand how current screening guidelines may be failing women 65 and older,” said the study’s lead author, UC Davis senior statistician Julian Cooley. “We need to focus on determining the prior screening history of older women as well as gaps in follow-up care.” We need to use non-invasive testing approaches for women who are approaching age 65 or those who need to catch up on their cervical cancer screenings.
The results of the study, published in Cancer Epidemiology, Biomarkers & Prevention on January 9, 2023, show that nearly one in five new cervical cancers diagnosed from 2009-2018 were in women 65 and older. More of these women (71%) had late-stage disease than younger women (48%), with late diagnoses increasing up to age 79. Five-year late-stage relative survival was lower in women 65 and older (23.2%-36.8%) compared to patients younger than 65 (41.5%-51.5%). Women 80 and older have the lowest survival of all age groups.
“Our study found worsening five-year relative survival for cervical cancer with each increasing age category for both early and late diagnoses,” said co-author Theresa Keegan, a professor in the UC Davis Department of Hematology and Oncology.
The California Cancer Registry provided critical data
The study used a large population-based data set from the California Cancer Registry. This state-mandated cancer surveillance system has collected demographic, diagnostic, and therapeutic information on cancer incidence and patients since 1988. The data was used to identify all women 21 and older who were diagnosed with a first primary cervical cancer in California from 2009-2018, the last 10 years for which complete data were available.
Among women 65 and older, those who had co-morbidities or were older were more likely to be diagnosed with late-stage disease.
“Interestingly, previous studies of younger women have found increased diagnoses of late-stage cervical cancer 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 to be diagnosed at a late stage than non-Hispanic white women.”
Current screening guidelines
Since the introduction and widespread acceptance of Pap smears in the 1940s, cervical cancer incidence and mortality have decreased 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, resulting in excellent survival rates. However, current guidelines recommend ceasing screening for women 65 years of age 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 US who are over 18 years old are not aware of the recommended screening for cervical cancer. Disadvantaged women, such as those who are uninsured or poor, are the least likely to report being aware of cervical cancer screening.
“Scheduled screenings may also decrease as women approach age 65, increasing the likelihood that women may not have received appropriate screening before the upper age limit,” said co-author and senior epidemiologist Frances Maguire.
Additional factors may contribute to older women not receiving appropriate screening:
- A specific type of hysterectomy. A supracervical hysterectomy leaves the cervix intact, and some women don’t realize they need to continue cervical cancer screening.
- Women may get tired of Pap smears because of the discomfort and intrusiveness of a speculum exam.
- Pap tests are less accurate. Screening may not be as accurate in postmenopausal women for detecting adenocarcinoma, the incidence of which is increasing (compared to squamous cell carcinoma).
- HPV testing. Women in the older age group may not have received an HPV test, now the gold standard for cervical cancer screening, which was not widely available until 2003. The Centers for Disease Control reports that nearly all cases of cervical cancer cervical are associated with HPV.
Acknowledgments
Other study authors include Cyllene R. Morris, Arti Parikh-Patel, Renata Abrahão and Hui A. Chen.
The study was funded by the UC Davis Comprehensive Cancer Center and the National Cancer Institute of the National Institutes of Health under award number P30CA093373. The collection of cancer incidence data used in this study was supported by the California Department of Public Health under California Health and Safety Code Section 103885; National Cancer Registries Program of the Centers for Disease Control and Prevention, under cooperative agreement 5NU58DP006344; National Cancer Institute Surveillance, Epidemiology, and End Results Program under contract HHSN261201800032I awarded to UC San Francisco, contract HHSN261201800015I awarded to the University of Southern California, and contract HHSN261201800009I awarded to the Public Health Institute.
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