Women Should Continue Cervical Cancer Screening As They Approach Age 65

Adjusted rates for cervical cancer do not decline until age 85, signaling a need for ongoing surveillance, according to a new study in the American Journal of Preventive Medicine


Ann Arbor, MI, May 1, 2017

Cervical cancer is often thought of as a disease that primarily affects young women. Because of this, many older women fail to keep up with appropriate screening as they age. While current guidelines indicate that screening can be stopped for average risk patients after age 65, many women lack the appropriate amount of screening history to accurately assess their risk. A new study in the American Journal of Preventive Medicine found that incidence rates of cervical cancer do not begin to decline until 85 years of age among women without a hysterectomy and that women over 65 who have not been recently screened may benefit from continued surveillance.

“An older woman who has not had her cervix surgically removed has the same or even higher risk of developing cervical cancer compared to a younger woman,” said lead investigator Mary C. White, ScD, Chief of the Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, GA. “Women who have not had a hysterectomy need to continue to be screened until age 65, and possibly later if they have not been screened for many years or are at special risk, consistent with current U.S. Preventive Services Task Force recommendations.”

In 2013, one-fifth of cervical cancer cases and one-third of cervical cancer deaths occurred among women 65 years of age and older. Current recommendations say that screening can be stopped at age 65 if an adequate testing history indicates consistently negative results. Three consecutive negative cytology results or two consecutive negative co-test results within the last 10 years, with the most recent test within the last 5 years, are considered sufficient reason to stop screening average risk women after age 65.

Using data from the 2013 and 2015 National Health Interview Survey (NHIS), investigators looked at the use of screening tests and rates of cervical cancer for women 65 years of age and older. They found that when corrected for hysterectomy, incidence rates of cervical cancer increased with age until 70 and did not begin to decline until age 85.

The data also revealed that many women approaching the “stopping” age of 65 were not getting sufficient screening. Researchers established that the proportion of women not recently screened increases with age. While only 12% of women in their 40s had no recent screening history, that number progressively increased for women in their 50s and 60s. Nearly 850,000 women aged 61-65 years had not been screened within the last five years.

“A recommended upper age limit for routine screening may lead women and providers to assume that cervical cancer is a younger women’s disease,” explained Dr. White. “After adjustment for hysterectomy, some of the highest cervical cancer incidence rates occur among women older than 65 years, with notably higher rates among older black women. Premature discontinuation of routine screening among women in the years before age 65 could contribute to preventable cases of invasive cervical cancer and deaths.”

Cervical cancer can affect women of all ages. This new study highlights the importance of regular screening for older women who are at high risk or without documentation of adequate prior screening in order to help prevent cervical cancer deaths. Going forward, given increases in life expectancy and the high rates of cervical cancer after 65, women in midlife need to continue with routine cervical cancer screening to look for changes that may need further follow-up.

“In the short term, efforts could be undertaken to clarify misperceptions about the risk of cervical cancer among older women and providers,” concluded Dr. White. “Messages about a ‘stopping age’ need to emphasize the recommendation for an adequate screening history of previous negative tests before screening is discontinued, not just chronologic age.”

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Notes for editors
The article is “Cervical Cancer Screening and Incidence by Age: Unmet Needs Near and After the Stopping Age for Screening,” by Mary C. White, ScD, Meredith L. Shoemaker, MPH, Vicki B. Benard, PhD (http://dx.doi.org/10.1016/j.amepre.2017.02.024). It will be published in the American Journal of Preventive Medicine, volume 53, issue 3 (September 2017) by Elsevier.

Full text of this article is available to credentialed journalists upon request; contact Jillian B. Morgan at +1 734-936-1590 or ajpmmedia@elsevier.com. Journalists wishing to interview the authors should contact the CDC Media office at +1 404 639-3286 or media@cdc.gov.

About the American Journal of Preventive Medicine
The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials.

The American Journal of Preventive Medicine, with an Impact Factor of 4.465, is ranked 14th in Public, Environmental, and Occupational Health titles and 16th in General & Internal Medicine titles for total number of citations according to the 2015 Journal Citation Reports® published by Thomson Reuters, 2016. www.ajpmonline.org

About Elsevier
Elsevier is a global information analytics business that helps institutions and professionals progress science, advance healthcare and improve performance for the benefit of humanity. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, more than 35,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX Group, a global provider of information and analytics for professionals and business customers across industries. www.elsevier.com

Media contact
Jillian B. Morgan, MPH
Managing Editor, AJPM
+1 734-936-1590
ajpmmedia@elsevier.com