Following a review of cervical cancer cases, calls have been made for urgent changes to cervical cancer screening recommendations, aiming to encourage routine screening for older women.
The review, published in The BMJ, found that in the UK, around 20% of new cases of cervical cancer diagnosed are in women aged 65 and over, along with around 50% of deaths. In comparison, the review found that just 2% of new cervical cancer diagnoses were made in women under the age of 25.
“We need to change the perception of cervical cancer so it is thought of just like breast and bowel cancer – that it can affect women well into old age,” explains lead author Dr. Sue Sherman, a senior lecturer in psychology at Keele University in the UK.
The American Cancer Society (ACS) estimate that this year, around 12,900 new cases of invasive cervical cancer will be diagnosed, with around 4,100 women dying from the disease. Although cervical cancer typically occurs during midlife, more than 15% of cases in the US occur in women over 65.
In the US, a regular Pap test is recommended for all women aged 21-65. This screening recommendation is similar to that given in the UK, where the cervical screening program begins at the age of 25 and currently ends at the age of 65.
According to the Centers for Disease Control and Prevention (CDC), if you are older than 65 and have had normal Pap test results for several years or have had a cervix removal for a noncancerous condition, your doctor may state that regular Pap tests are no longer necessary.
The review found that women are less likely to be screened for cervical cancer after the age of 50. In 2013, 82% of women aged 50-54 reported being screened in the past 5 years, compared with 76% of 55-59 year olds and 73% of 60-64 year olds.
Uptake for cervical cancer screening in older women after the age of 50 contrasts with reported uptake for breast screening, where uptake increases between the ages of 50 and 64.
Ending recommended screening at this age implicitly suggests, the authors argue, that older women are no longer at risk. However, the findings of the review indicate that this is not the case.
A study conducted by the charity Jo’s Cervical Cancer Trust found that a major contributing factor to women aged 50-65 not attending cervical screening was a lack of knowledge about the cause of the cancer. Around 60% were unaware that human papillomavirus (HPV) was a cause, and that historical sexual activity could lead to the virus lying dormant and developing into cancer in the future.
“This review suggests that older women not getting themselves screened for cervical cancer has become a significant contributor to the number contracting the disease,” states Dr. Sherman.
However, the review also found that repeated screening reduces the risk of cervical cancer diagnosis. In women aged 65-85, the researchers found 8 in 10,000 with negative test screenings between 50-64 were likely to contract the cancer. In contrast, 49 in every 10,000 women who were not screened between 50-64 developed the disease.
“Encouragingly we found that women with three negative tests for cervical cancer between 50 and 64 are considerably less likely to get the disease in the next 20 years,” explains Dr. Sherman. “So regular screenings have the potential to catch the disease early and reduce the victims of cervical cancer dramatically.”
As a result of the review’s findings, the researchers believe the upper age limit for cervical screening in the UK should be revisited, and recommend that awareness campaigns are used to target older and younger women.
The chief executive of Jo’s Cervical Cancer Trust, Robert Music, believes that it is vital that women of all ages are educated around the cause of cervical cancer and their risk of HPV:
“Responses from women questioned in our research were worrying, with some citing they had been ‘celibate’ for several years and therefore did not consider themselves to be at risk. We must remind all women that HPV is very common and can lie dormant for very long periods of time, and that the best way of reducing one’s risk of cervical cancer is to attend screening promptly whilst eligible.”
Earlier this year, Medical News Today reported on two studies that found screening for HPV infection alone provided more accurate results than the Pap test for cervical cancer screening.