Burden of cervical cancer remains high in women aged 65 years and older

Among California patients with cervical cancer, women aged 65 years and older had a greater disease burden compared with younger women, researchers reported.

“Our findings highlight the need to better understand how current screening guidelines might be failing women 65 and over,” Julianne J.P. Cooley, MS, a senior statistician at University of California Davis Health in Sacramento, said in a press release.

ACOG, the U.S. Preventive Services Task Force and the American Cancer Society recommend that cervical cancer screening end once women reach age 65 years and have sufficient negative screening within the past 10 years. However, “as many as 58% of women of 64- to 66-year-olds in a national database failed to meet the criteria to screening,” according to study background.

Cooley and colleagues identified 12,442 patients aged 21 years or older in the California Cancer Registry who were diagnosed with first primary cervical cancer between 2009 and 2018. The researchers analyzed sociodemographic and clinical characteristics — including cancer stage and subtype, comorbidity, neighborhood socioeconomic status, health insurance, urbanicity, marital status, race/ethnicity and age and year of diagnosis — by age group.

In total, 2,171 (17.4%) women were aged 65 years or older.

The proportion of women in each age group who were diagnosed with cervical cancer at stage II or later — termed late-stage — increased with age through the 75- to 79-year age group. For women aged 65 years or older, the proportion of late-stage diagnosis ranged from 60.2% to 70.6% vs. 33.5% to 58.7% among younger women.

Five-year relative survival decreased with age. The survival rate for younger women ranged from 89.3% to 93.6% and from 51.6% to 81.5% among women aged 65 years or older. For women with late-stage cervical cancer, 5-year relative survival ranged from 23.2% to 39.1% among women aged 65 years or older and from 41.5% to 51.5% among younger women. Five-year survival was lowest for women aged 80 years or older.

Among women aged 65 years or older, late-stage diagnosis was more common with older age at diagnosis (OR = 1.02; 95% CI, 1.01-1.04, for each year of age), two or more comorbidities vs. no comorbidities (OR = 1.59; 95% CI, 1.21-2.08) and squamous cell carcinoma (OR = 1.38; 95% CI, 1.1-1.74) or other subtypes (OR = 2.52; 95% CI, 1.68-3.79) vs. adenocarcinoma.

Hispanic women had a lower likelihood of late-stage diagnosis vs. non-Hispanic white women (OR = 0.76; 95% CI, 0.6-0.97). Other sociodemographic factors were not associated with late-stage diagnosis.

“We need to focus on determining the past screening history of older women as well as lapses in follow-up care,” Cooley said in the release. “We must utilize noninvasive testing approaches for women nearing age 65 or those who need to catch up on their cervical cancer screenings.”

References:

• Cooley JJP, et al. Cancer Epidemiol Biomarkers Prev. 2023;doi:10.1158/1055-9965.EPI-22-0793.
• Winn S. Study finds increase in women 65 and older dying of cervical cancer. https://health.ucdavis.edu/news/headlines/study-finds-increase-in-women-65-and-older-dying-of-cervical-cancer--/2023/01. Published Jan. 9, 2023. Accessed Jan. 11, 2023.