Cervical cancer screening decreased among older women but may remain higher than needed

Despite decreases in cervical cancer screenings between 1999 and 2019 among older women with Medicare fee-for-service coverage, this group may be overspending on screening-related services, according to data in JAMA Internal Medicine.

The U.S. Preventive Services Task Force in 1996 recommended against routine cervical cancer screening for women older than 65 years who had received normal results with past screenings. The researchers aimed to characterize the use of HPV testing/cytology, colposcopy and cervical procedures over the past 20 years and to determine how much women in this population continue to spend on these services, according to the researchers.

“Use of cervical cancer screening-associated services in women 65 years and older at the population level is largely unknown,” Jin Qin, ScD, an epidemiologist at the CDC, and colleagues wrote. “It is also unknown how changing guidelines and recommendations have been associated with use of these services in women older than 65 years.”

Qin and colleagues analyzed Medicare claims data available from 1999 to 2019 for women who were enrolled in Medicare fee-for-service. Specifically, individuals were enrolled in Medicare Part A and B fee-for-service for 11 or 12 months or until time of death and had coverage from an HMO for 1 month or less during the calendar year. Women were divided into four groups by age: 65 to 69 years, 70 to 74 years, 75 to 79 years and 80 to 114 years.

In total, 15,323,635 women had Medicare fee-for-service coverage in 1999 and 15,298,656 had coverage in 2019.

Cytology, HPV testing rates

From 1999 to 2019, the annual usage rate of HPV or cytology tests decreased from 18,925.2 to 8,463.9 per 100,000 women. This was a reduction of 55.3%.

Analyses by age group revealed that women aged 65 to 69 years received 28.5% of the cytology and HPV tests in 1999, compared with 16.7% among women aged 80 years or older. In 2019, 41.2% of these tests were performed in women aged 65 to 69 years and 10% were performed in women aged 80 years or older.

Age-adjusted analyses showed that the annual usage rate of cytology and HPV testing decreased by an average of 4.6% per year during the study period. The decrease was distinctly divided into two segments, with a 3.1% decrease each year through 2009 and a 6.1% decrease each year from 2009 onward.

Colposcopy, cervical procedure rates

The annual usage rate of colposcopy was 338 per 100,000 women in 1999, which decreased by 43.2% to 192.1 per 100,000 women in 2019. For cervical procedures the annual usage rate decreased by 64.4% from 55.4 per 100,000 women in 1999 to 19.7 per 100,000 women in 2019.

From 1999 to 2019, the age-adjusted usage rates for colposcopy and cervical procedures decreased on average by 3% and 5.3% per year, respectively. For both procedures, the age-adjusted annual usage rate decreased significantly through 2015, when the overall rate of use plateaued. Among women aged 65 to 69 years, however, there was an increase in colposcopy starting in 2015.

Notably, Medicare paid $83,527,181 for all services associated with cervical cancer screening for women enrolled in Medicare fee-for-service in 2019, $76,083,414 of which was spent on cytology and/or HPV testing.

Additionally, Medicare spent $7,391,101 in 2019 for at least one service for 2.8% of women aged 80 years or older, which may indicate overuse of testing in this population, according to the researchers.

Moving forward, the researchers said, more study is needed on the benefits, detriments and cost-effectiveness of screening for cervical cancer in older populations.