Navigating Cancer 7/18/2017: Cervical cancer screening beyond 50

By Dr. Joseph Bennett

Over the past five years, a great deal of debate has taken place in the medical community regarding cancer screening as we age, and whether or not we stop screening with a detrimental effect on our health as we age.

This debate has involved mammography, and PSA testing in men, and often recommendations are made based upon cost, and not out of concern for our health and well-being. Today, the topic of PAP smears for early detection of cervical cancer are in the crosshairs of the pencil pushers who want to save money.

Cervical cancer is often thought of as a disease that primarily affects young women. Because of this, many older women fail to keep up with appropriate screening as they age.

While current guidelines indicate that screening can be stopped for average-risk patients after age 65, many women lack the appropriate amount of screening history to accurately assess their risk.

A new study recently published in the American Journal of Preventive Medicine found that incidence rates of cervical cancer do not begin to decline until 85 years of age among women without a hysterectomy, and that women over 65 who have not been recently screened may benefit from continued surveillance.

Finally, a recommendation based upon what is right for the patient.

An older woman who has not had her cervix surgically removed has the same or even higher risk of developing cervical cancer compared to a younger woman. Women who have not had a hysterectomy need to continue to be screened well beyond the age of 65, if they have not been screened for many years or are at special risk, consistent with current U.S. Preventive Services Task Force recommendations.

In 2013, one-fifth of cervical cancer cases and one-third of cervical cancer deaths occurred among women 65 years of age and older. Current recommendations say that screening can be stopped at age 65 if an adequate testing history indicates consistently negative results. At this time, three consecutive negative PAP smear results within the last 10 years, with the most recent test within the past five years, are considered sufficient reason to stop screening the average risk woman after age 65. But is this really a good idea?

Using data from the 2013 and 2015 National Health Interview Survey (NHIS), investigators looked at the use of screening tests and rates of cervical cancer for women 65 years of age and older. They found that the incidence rates of cervical cancer increased with age until 70, and did not begin to decline until age 85. If we stop screening at age 65, we will miss the opportunity to detect early cancers and pre-cancerous changes that can be treated effectively, and we will see the death rate from cervical cancer increase.

The data also revealed that many women approaching the age of 65 were not getting sufficient screening. Researchers found that the proportion of women not recently screened increases with age. While only 12 percent of women in their 40s had no recent screening history, that number progressively increased for women in their 50s and 60s. Nearly 850,000 women aged 61-65 years had not been screened within the past five years. Yes, nearly 1 million women are putting themselves at risk of dying from cervical cancer.

As I have stated before, screening should not be based upon a person's age, but should be based upon their life expectancy and health status. A recommended upper age limit for routine screening may lead women and physicians to assume that cervical cancer is a younger woman's disease. We must realize that some of the highest cervical cancer incidence rates occur among women older than 65 years, with notably higher rates among older black women. Premature discontinuation of routine screening among women in the years before age 65 will contribute to an increase in preventable cases of invasive cervical cancer and deaths.

Please remember, cervical cancer can affect women of all ages. This new study highlights the importance of regular screening for older women in order to help prevent cervical cancer deaths. Going forward, given increases in life expectancy and the high rates of cervical cancer after 65, women in midlife need to continue with routine cervical cancer screening to look for changes that may need further follow-up.

The take-home message is that screening for cancer should not have a "stopping age;" we need to emphasize the recommendation for an adequate screening based upon a person's health and life expectancy, not just some random chronologic age.

Dr. C. Joseph Bennett Jr. is a board-certified radiation oncologist. If you have any suggestions for topics, or have any questions, contact him at 522 N. Lecanto Highway, Lecanto, FL 34461, or email cjbennett@rboi.com.