Adult women are recommended to undergo regular screening for cervical cancer until the age of 65 years. At 65, current recommendations call for the cessation of cervical cancer screening in women who have adequate negative prior screening and who are not at increased risk for the disease. Results of a recent study may call this recommendation into question.
The 2012 recommendations calling for cessation of screening at age 65 years were issued by two groups, the US Preventive Services Task Force (USPSTF) and a multidisciplinary partnership among the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology.1,2 The USPSTF recommendation was graded as a “D” recommendations, meaning that the group found “no net benefit or that the harms outweigh the benefit” of the screening procedure.
However, in a study published in PLoS Medicine, Peter Sasieni, and colleagues from Queen Mary University of London, United Kingdom, found that there may in fact be benefits for continuing to screen women for cervical cancer past age 65 as the protective effect of screening weakens with time.3
According to an accompanying editorial by Anne F. Rositch, PhD, of the University of Maryland School of Medicine, and colleagues, the data from Sasieni et al calls increased attention to the fact that “estimates of risk of invasive cervical cancer following negative screening tests in older women” are insufficient to adequately inform the current recommendations.4
Decreasing Protective Effect
Sasieni and colleagues3 conducted a case control study looking at the link between women screened for cervical cancer from age 50 to 64 years and a cervical cancer diagnosis between ages 65 to 83 years. The data were drawn from population registers that included all women aged 65 to 83 years in England and Wales with a diagnosis of cervical cancer between 2007 and 2012 (n=1,341). These women were then age-matched to control women.
The results showed that those women who had adequate negative screening at age 65 years—at least 3 tests between ages 50 and 64 years with the last negative screening occurring after age 60—were 6 times less likely to have a diagnosis of cervical cancer compared with those women not screened at age 50 to 64 years. Screened women had a 20-year risk of 8 cancers per 10,000 women, compared with 49 cancers per 10,000 women in those not screened.
In addition, there was a 75% reduced risk of cervical cancer between the ages of 65 and 79 years for women who underwent screening at least every 5.5 years from age 50 to 64 years. Without cervical cancer screening, the researchers estimated that cervical cancer rates in women aged 65 years or older would have been 2.4 times greater.
However, the odds ratio for a cervical cancer diagnosis in women who had adequate negative screening increased with increasing age. The odds ratio for cervical cancer was 0.07 for ages 65 to 69 years, was 0.28 for ages 75 to 79 years, and was 0.37 for ages 80 to 83 years.
“Screening up to age 65 years greatly reduces the risk of cervical cancer in the following decade, but the protection weakens with time and is substantially less 15 years after the last screen,” the researchers wrote. “In the light of increasing life expectancy, it would seem inappropriate for countries that currently stop screening between the ages of 60 and 69 years to consider reducing the age at which screening ceases,” Sasieni and colleagues wrote.3
1. Screening for Cervical Cancer. Available at: http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm. Accessed on January 13, 2013.
2. Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin. 2012;62:147-172.
3. Castañón A, Landy R, Cuzick J, Sasieni P. Cervical screening at age 50-64 years and the risk of cervical cancer at age 65 years and older: population-based case control study. PLoS Med. 2014;11:e1001585. doi:10.1371/journal.pmed.1001585.
4. Rositch AF, Silver MI, Gravitt. Cervical cancer screening in older women: new evidence and knowledge gaps. PLoS Med. 2014;11: e1001586. doi:10.1371/journal.pmed.1001586.