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

A new study by researchers at the UC Davis Comprehensive Cancer Center shows that an alarming number of California women age 65 and older are being diagnosed with late-stage cervical cancer and dying from the disease. This is despite guidelines recommending that most women stop screening for cervical cancer at this age.

“Our findings highlight the need to better understand how current screening guidelines may be failing women age 65 and older,” said the study’s lead author, UC Davis statistician Julianne Cooley. “We need to focus on finding out the past screening history of older women as well as gaps in follow-up care. We need to use non-invasive testing approaches in women approaching age 65 or those who need to catch up on cervical cancer screening.” “

The conclusions of the study published inCancer epidemiology, biomarkers and prevention On January 9, 2023, they showed that nearly one in five new cervical cancers diagnosed between 2009-2018 were in women aged 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 over (23.2%-36.8%) compared with patients younger than 65 (41.5%-51.5%). Women aged 80 years and older had the lowest survival of all age groups.

Our study found a worsening five-year relative survival for cervical cancer with each increasing age for both early and late diagnoses.”

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

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 been collecting cancer incidence and patient demographic, diagnostic, and treatment information since 1988. The data was used to identify all women aged 21 and older who were diagnosed with a first primary cervical cancer in California between 2009-2018. , the last 10 years when complete data were available.

Among women aged 65 years and older, those who had comorbidities 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 in 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

After the introduction and widespread acceptance of the Papanicolaou (Pap) smear test in the 1940s, cervical cancer incidence and mortality decreased significantly. However, the incidence rate has stagnated since 2012, and the rate of invasive cervical cancer has actually increased in recent decades.

Through 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 in women aged 65 years or older who have had a history of normal Pap tests and/or human papillomavirus (HPV), potentially leaving this age group vulnerable.

Noncompliance with screening

Previous studies have shown that 23.2% of US women over the age of 18 do not have current information about recommended cervical cancer screening. Disadvantaged women, such as those who are uninsured or poor, are the least likely to report cervical cancer screening.

“Scheduled screenings may also decrease as women approach age 65, making it more likely that women were not adequately screened before the upper age limit,” said co-author and lead epidemiologist Frances Maguire.

Other factors may contribute to older women not receiving adequate 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.
  • Discomfort. Women may be weary of PAP smears because of the embarrassment and intrusiveness of a spectrum-based exam.
  • Pap tests less accurate. Screening may not be as accurate in postmenopausal women in 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 HPV testing, which is 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 are related to HPV.

Source:

University of California – Davis Health

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