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Study results call into question upper age limit for cervical cancer screening
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The upper age limit for cervical cancer screening may need to be increased, according to researchers who presented preliminary findings at this year’s Society of Gynecologic Oncology Annual Meeting on Women’s Cancer.
Guidelines recommend women stop undergoing cervical cancer screening after age 65 years. However, anecdotal reports indicated a considerably higher number of older women than might be expected present with cervical cancer.
For this reason, Sarah E. Dilley, MD, fellow at The University of Alabama at Birmingham, and colleagues evaluated the cervical cancer burden among women aged 65 years and older. They also assessed age- and race-related differences in cervical cancer incidence.
The researchers used the National Cancer Database and SEER database to gather data about cervical cancer cases from 2000 to 2014.
Dilley and colleagues determined nearly 19% of cervical cancer cases identified through the National Cancer Database occurred among women aged older than 65 years, and nearly 20% of cases identified through the SEER database occurred among that same age group.
HemOnc Today spoke with Dilley about the study, the implications the results may have on screening policies in the United States, and the potential impact a higher upper age limit for screening may have on patient outcomes.
Question: What prompted this research?
Answer: My mentor, Warner K. Huh, MD, professor and director in the department of obstetrics and gynecology at The University of Alabama at Birmingham, and I were clinically seeing a lot of older women with cervical cancer than one might expect based upon what current evidence suggests. We conducted some preliminary research looking at cervical cancer among older women and we wanted to dive into this with more detail.
Q: How did you conduct the study?
A: We searched the National Cancer Database and SEER database and queried data to identify rates of cervical cancer among women by age. We examined these rates over time and stratified by race. We also assessed incidence rates based upon age group using the SEER database. Our full study has not yet been published; we are finalizing the data now.
Q: What did the preliminary data suggest?
A: We found that approximately 20% of all cervical cancer cases occur among women aged 65 years or older. These numbers were consistent across the two databases. When we broke this down by race, results showed a slightly higher percentage of non-Hispanic black women aged 65 years and older with cervical cancer (23%) compared with non-Hispanic white women. When we looked at the population incidence rate for cervical cancer, we found that when we removed women who had undergone hysterectomy, the rate for cervical cancer was even higher among women aged 65 years and older. This was especially true for black women. A potential limitation of our research is that we were unable to exclude women who were not screened or who were screened inappropriately.
Q: Why do you think the rates were higher among black women?
A: Part of the reason for this is that there are higher rates of hysterectomy in certain racial groups. In general, the higher incidence rates among older women is a sign that we may be missing cases of cervical dysplasia early on, and these women may not have been receiving routine screenings. Previous data are mixed as to whether there are racial disparities in cervical cancer screening practices, but we do know that, in general, incidence and mortality rates for cervical cancer are worse among black women.
Q: What are the potential implications of the findings?
A: There is consideration for potentially increasing the cervical cancer screening age to beyond 65 years — either through guidelines or at the individual level of obstetricians/gynecologists taking into account a patient’s personal health history and realizing that just because a woman is older than age 65 does not mean that they are not at risk for cervical cancer. A screening test is supposed to be sensitive and capture as many women at risk as possible. By placing an arbitrary number as a cutoff, we are not taking into account that there are women who are lost to follow-up and those who exit screening inappropriately.
Q: What impact could a higher upper limit on screening age have on patient outcomes?
A: We can catch cervical cancer at an earlier stage, when women are eligible for more minimally invasive or less harmful treatments. We have an aging population, and we know that the life expectancy is increasing. Over time, the incidence rate for cervical cancer is going down. However, the number of absolute cases of cervical cancer is not going down. We have to take into consideration that our population is aging.
Q: Is there anything else that you would like to mention?
A: Although most women who are diagnosed with cervical cancer are in their 40s, we cannot ignore the fact that older women are still affected by this disease. However, our data need to be taken in context, and there are many factors — including screening history — that contribute to a patient’s risk for cervical cancer. A limitation of our data is that we did not take into account prior screening and, therefore, we do not know which women who were diagnosed at a later age were not screened appropriately. This will be a next step for research. – by Jennifer Southall
Reference:
Dilley S, et al. Abstract 55. Society of Gynecologic Oncology Annual Meeting on Women’s Cancer; March 24-27, 2018; New Orleans.
For more information:
Sarah E. Dilley, MD, can be reached at The University of Alabama at Birmingham, 1720 2nd Ave. South, Birmingham, AL 35294; email: sdilley@uabmc.edu.
Disclosure: Dilley reports no relevant financial disclosures.