Cervical cancer is not just a young woman's disease

Abstract

colleagues argue that the upper age limit for cervical screening needs revisiting and call for awareness campaigns to target older as well as younger women Cervical screening programmes in many countries stop at around the age of 65 and much of the focus is often on younger women. For example, recent media campaigns in England and Wales have centred on lowering the age at first screening. Comparatively little attention has been given to older women despite the fact that they account for about a fifth of cases each year and half of deaths.1 2 Of the 3121 women diagnosed on average each year between 2009 and 2011 in the UK, only 64 were younger than 25 compared with 616 who were older than 65.1 As the population ages, this number of older women affected is set to increase. We argue that screening programmes should reflect this. Age distribution of casesThe raw statistics conceal the full impact of cervical cancer on older women. Although the absolute figures decrease with increasing age, when the rate of new cases per 100 000 women is considered, a second peak in diagnoses after the age of 65 becomes apparent (table⇓). The case rate gradually decreases from 19.7 new diagnoses per 100 000 women aged 30-34 to a low of 8.6/100 000 women aged 65-69, but then rises again, reaching 12.5/100 000 in women aged 80-84. Furthermore, mortality data for the UK from 2010-12 show only seven deaths a year from cervical cancer in women younger than 25 but 449 deaths in women older than 65-nearly half of the total average deaths from cervical cancer in any year. Although recent research by Castanon and colleagues suggests that women aged 65 who have had regular screening with negative results have a relatively low 20 year risk of 8/10 000 women, it also reports that for those women who have not been screened between the ages of 50 and 64, the 20 year risk rises to 49/10 000 women.3 This raises several issues. Screening uptake falls in older womenThe proportion of women in England in 2013 who had been screened in the past five years dropped with age, from 82.4% of 50-54 year olds to 75.9% of 55-59 year olds and 72.7% of 60-64 year olds. 4 These numbers are set to fall further because uptake is decreasing across all age groups. More than 25% of older women would therefore not be in the low risk group defined by Castanon and colleagues. 3 The fall in uptake suggests that as women age they perceive cervical screening to be less important. This is supported by Waller and colleagues, 5 who found that only 12% of 55-64 year old women cited not attending screening as a risk factor for cervical cancer. In addition, only 2.1% of participants across their whole sample identified older age as a risk factor, suggesting that it is perceived as being a younger woman's disease. This interpretation is strengthened by the fact that the age related decline in screening uptake seems to be specific to cervical screening. The 2010-11 breast cancer screening data show that 70.7% of invited women aged 45-49 attended breast screening, increasing to 74.9% i...

Psycho-social influences upon older women's decision to attend cervical screening: A review of current evidence

“…This is at odds with evidence from age-stratified incidence and mortality data (Sherman, Castanon, Moss & Redman, 2015). Between 2011 and 2013, 2.4% of cervical cancer diagnoses were among women under 25 years, whereas 20.0% of diagnoses were made in women aged 65+ (Cancer Research UK, 2016b).…”

Cervical Cancer Screening and Incidence by Age: Unmet Needs Near and After the Stopping Age for Screening

“…13 Some of the highest cervical cancer incidence rates occur among women aged >65 years, with notably higher rates among older black women. These results, representing 99% of the U.S. population, confirm those of Rositch and colleagues 12 using data from 4–13 years earlier and 13 states.…”

“…Catch-up screening may be needed for underscreened women after age 65 years, taking into account the physical and psychological issues associated with cervical cancer screening decisions for older women. 13,15 In the short term, efforts could be undertaken to clarify misperceptions about the risk of cervical cancer among older women and providers. Messages about a “stopping age” should emphasize the recommendation for an adequate screening history of previous negative tests before screening is discontinued, not just chronologic age.…”

Racial/Ethnic Disparities in Cervical Cancer Screening and Outcomes

“…This delay has also been shown to be improved, with reduced loss to follow-up in all racial/ethnic groups, when patient navigators are available [37,38]. …”

“…In another study of early-stage ICC management, minority women were less likely to undergo a hysterectomy and more likely to be treated with fertility-sparing, less definitive procedures. These discrepancies have been hypothesized to be related to increased comorbidities, patient choice to decline the recommended treatment, and provider bias in treatment recommendations in minority patients [37,47], which have also been observed in the treatment of other diseases [48]. …”