Study finds alarming number of older women facing late-stage cervical cancer diagnosis and death

A new study led by researchers at the UC Davis Comprehensive Cancer Center shows that an alarming number of California women aged 65 and over are diagnosed with late-stage cervical cancer and die from the disease. This is despite guidelines that recommend that most women discontinue cervical cancer screening at this age.

«Our findings highlight the need to better understand how current screening guidelines are failing women 65 and older,» said Julianne Cooley, senior statistician at UC Davis, lead author of the study. «We should focus on identifying older women’s past screening histories and deficiencies in follow-up care. For women approaching 65 years of age or who need to complete cervical cancer screening, we should leverage non-invasive testing approaches.»

Findings from research published in the journalCancer Epidemiology, Biomarkers and Prevention On January 9, 2023, it showed that about one in five new cervical cancers diagnosed between 2009 and 2018 were in women aged 65 and over. Most of these women (71%) presented with advanced-stage disease than younger women (48%), and the number of late-stage diagnoses increased by age 79. above (23.2% – 36.8%) compared to patients under 65 years (41.5% – 51.5%). Women aged 80 and over had the lowest survival rate of all age groups.

Our study worsened the five-year relative survival from cervical cancer with each increasing age category for both early- and late-stage diagnoses.»

Theresa Keegan, co-author, professor in the UC Davis Department of Hematology and Oncology

California Cancer Registry provided critical data

The study used large numbers of population-based data from the California Cancer Registry. This government-mandated cancer monitoring system has been collecting cancer incidence and patient demographic, diagnostic and treatment information since 1988. The data were used to identify all women aged 21 and older who were first diagnosed with primary cervical cancer in California between 2009 and 2018. , the last 10 years for which complete data are available.

Among women age 65 and older, those with co-morbidities or those who were older were more likely to be diagnosed with late-stage disease.

«Interestingly, previous research on young women found an increase in late-stage cervical cancer diagnoses among young Hispanic/Latino and Black women,» said Cooley. «Our study did not observe these associations and instead found that older Hispanic/Latino women were less likely to be diagnosed at a late stage than non-Hispanic white women.»

Current scanning guidelines

After the introduction and widespread adoption of the Papanicolaou (Pap) smear test in the 1940s, the incidence and mortality of cervical cancer has dropped significantly. However, incidence rates have stabilized since 2012, and rates of invasive cervical cancer have actually increased in recent decades.

With adequate screening and follow-up, cervical cancer can be prevented or detected at an early stage, leading to excellent survival. However, current guidelines recommend discontinuing screening for women aged 65 and over with a history of normal Pap and/or Human Papillomavirus (HPV) tests, potentially leaving this age group vulnerable.

Lack of compliance with screening

Previous research has shown that 23.2% of women over the age of 18 in the US are not up-to-date on recommended cervical cancer screening. Disadvantaged women, such as those without insurance or poor, are the least likely to report being up-to-date on cervical cancer screening.

«As women approach age 65, scheduled screenings may also decrease, making it more likely that women are not adequately screened by the upper age limit,» said co-author and senior epidemiologist Frances Maguire.

Additional factors may contribute to older women not getting adequate screening:

• Specific type of hysterectomy. Supracervical hysterectomy leaves the cervix intact, and some women do not realize they need to continue screening for cervical cancer.
• discomfort. Women can get sick of PAP smears because of the embarrassment and intrusiveness of a speculum-based exam.
• Pap tests are less accurate. Screening may not be as accurate in detecting adenocarcinoma, which has an increased incidence in postmenopausal women (compared to squamous cell carcinoma).
• HPV test. Women in the older age group may not have had HPV testing, which was no longer the gold standard of cervical cancer screening, which was not widely available until 2003. The Centers for Disease Control reports that nearly all cases of cervical cancer are associated with HPV.