Many Women Over 65 Are Dying of Cervical Cancer. What Needs to Change?
A new study shows that many women diagnosed with and dying from cervical cancer are older than 65 -- a group for whom routine screening is usually not recommended.
Cervical cancer screening has been credited with a sharp drop in deaths from the disease in the decades since it was introduced in the United States. But current guidelines state that once a woman reaches 65, if she has been regularly screened and gotten a series of normal results in recent years, screening is no longer needed.
However, women in that age group can and do develop cervical cancer -- and are often diagnosed at a late stage, research has shown. The new study confirms that in a large group of women.
Researchers found that among over 12,000 California women diagnosed with cervical cancer between 2009 and 2018, 17% were 65 or older. And most of them -- 71% -- had advanced cancer. That compared with 48% of younger women who were diagnosed with the disease.
The findings do not, however, point to a shortcoming in the screening guidelines, experts stressed.
Researchers did not look at whether women had been adequately screened, or ever screened, before they were ultimately diagnosed with cervical cancer.
But other studies have looked at that question, said Debbie Saslow, managing director of cancer control interventions for HPV and gynecological cancers at the American Cancer Society (ACS).
"Most women who get cervical cancer have never been screened in their lives, or have only rarely been," Saslow stressed.
The new findings, she added, are highlighting a known problem with guideline adherence -- not the guidelines themselves.
The ACS is among the medical groups that say women can stop cervical cancer screening after age 65 -- if they have had routine screening for the past 10 years, with normal results.
Screening for cervical cancer should begin at age 25, the ACS says, and it can be done different ways. The preferred method, done every five years, is with a "primary" HPV test. Certain strains of HPV (human papillomavirus) cause most cases of cervical cancer, and HPV testing can detect those strains in a sample of cells collected from the cervix.
The other screening options are an HPV test plus a traditional Pap test -- where cervical cells are examined for pre-cancerous changes -- done every five years; or a Pap test alone every three years.
What matters, Saslow stressed, is that women get some kind of recommended screening, and keep it up. "We know we need to do a better job with screening and follow-up," she said.
Julianne Cooley, the lead researcher on the new study, agreed that it does not mean that screening recommendations are wrong.
"We can't say the guidelines, themselves, are failing women," said Cooley, of the University of California, Davis, Comprehensive Cancer Center.
If a woman older than 65 has been getting regular screening, and her doctor tells her she can stop, she can trust that advice, both Saslow and Cooley said.
"Older women who've been getting screened as recommended aren't the ones getting cervical cancer," Saslow said.
But, Cooley noted, many women approaching age 65 may not be sure whether they've been adequately screened in the past.
"It's so important for women and their doctors to suss that out," she said.
The findings, published recently in the journal Cancer Epidemiology, Biomarkers & Prevention, are based on data from a California cancer surveillance program. Between 2009 and 2018, more than 12,000 women in the state were diagnosed with cervical cancer, just over 17% of whom were age 65 or older.
There are definitely barriers to getting the recommended screening, Saslow said. Lower-income women without health insurance are among those least likely to be up-to-date with cervical cancer screening.
Still, "continuing to screen women until they're 90 wouldn't address the real problem," Saslow said.
She pointed to something that could truly move the needle: Home-based HPV tests that allow women to collect vaginal or urine samples themselves, to send in for analysis. They are available in some countries, but not yet approved by the U.S. Food and Drug Administration.
"That's our biggest hope for cervical cancer -- self-testing," Saslow said. "That will help increase screening rates for underserved women of all ages."
Cooley agreed that "less intrusive" testing could help a lot.
She also stressed that not only can cervical cancer be detected early, it can also be prevented. Screening can catch precancerous changes in tissue that can then be treated.
And now there's vaccination, Saslow pointed out: The current HPV vaccine, which protects against major cancer-causing strains of the virus, is recommended for girls and boys starting at age 11, with a second dose given six months to one year after the first.
HPV vaccination was first introduced in the United States in 2006, and research has since shown it is paying off.
"The number of cervical cancer cases among the youngest women is plummeting because of vaccination," Saslow said.
The American Cancer Society has an overview of cervical cancer.
SOURCES: Julianne Cooley, MS, senior statistician, University of California Davis Comprehensive Cancer Center; Debbie Saslow, PhD, managing director, cancer control interventions, HPV and gynecological cancers, American Cancer Society, Atlanta; Cancer Epidemiology, Biomarkers & Prevention, Jan. 9, 2023, online
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