Must Cervical Screening Be Discontinued At The Age Of Fifty?

Editor's Choice
Main Category: Cervical Cancer / HPV Vaccine
Also Included In: Women's Health / Gynecology;  Sexual Health / STDs
Article Date: 24 Apr 2009 - 0:00 PDT

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According to a study published on bmj.com, since the beginning of planned cervical screening programs which started in Europe more than forty years ago, there have always been debates about the maximum age limit for efficient screening. The study concludes that screening for cervical cancer should not stop after the age of fifty, since the risk is comparable to that of younger women, even following several negative smear results.

Several researchers recommend the age limit should even be less than fifty years since there is proof that repeated tests in women previously testing negative, aged sixty to sixty five, have only a small advantage or none at all.

In search of verification, researchers at the Erasmus Medical center in The Netherlands and the University of Copenhagen in Denmark studied the levels of cervical cancer following a number of negative smears at different ages.

They gathered information from a national cancer register in The Netherlands (PALGA) and selected two age groups: 219,000 women forty five to fifty four years old, and 445,000 women thirty to forty four years old. They all had three straight negative smear tests. Cases of cervical cancer were then recorded during the following ten years.

Throughout the investigation, the levels of screening were comparable in both age groups, and ten years later, the incidence of cervical cancer was similar in both groups. There were 41 cases per 100,000 in the younger group and 36 cases per 100,000 in the older group, suggesting that the risk of developing cervical cancer is not linked to age, among closely screened women without prior complications.

The authors say that with this evidence as a basis, it is safe to presume that following various successive negative results the efficiency of detection and prevention of cervical cancer is similar at around the age of fifty and at younger ages.

Whether the experiential frequency rates justify continued screening should be determined by succeeding analysis. But the study points out that it is not recommended to stop screening these women and also not slackening the screening strategy for younger women with similar screening histories.

In conclusion, the study sustains to the existing English cervical cancer screening guidelines which is similar in other developed countries and does not differentiate women by age up to sixty five years.

In a supplementary editorial, Björn Strander, Director of cervical screening at Sahlgren's University Hospital in Sweden recommends considering closely the evolution of invasive cancer in age groups over the limit for screening and being ready to change screening age along with further knowledge.

He says that screening schedules could be fitted for every individual with the use of modern computer technology. Possibly resources will then be redistributed to women who would benefit from additional smears during a particular length of time. The dilemma of whether to screen beyond the age of sixty would then be responded affirmatively for those who benefit the most from it.

"Research: Incidence of cervical cancer after several negative smear results by age 50: prospective observational study"
BMJ online
http://www.bmj.com/cgi/doi/10.1136/bmj.b1354

"Editorial: At what age should cervical screening stop?"
BMJ online
http://www.bmj.com/cgi/doi/10.1136/bmj.b809

Written by Stephanie Brunner (B.A.)
Copyright: Medical News Today
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