A fifth of cervical cancer diagnoses are in women over 65, most with advanced disease

A California study of women diagnosed with Cervical cancer, finds that about 20% of new cases were in women aged 65 and over. The study, published in Cancer epidemiology, biomarkers and prevention found that more older women were diagnosed with advanced disease than younger women.

Current guidelines from the American Cancer Society, the US Preventive Services Task Force, and the American College of Obstetricians and Gynecologists all recommend that women 65 and older should no longer be screened for cervical cancer. if a series of previous tests were normal. “But we know that many women in the United States – about 23% of women over 18 – are not being screened as guidelines recommend,” said lead author Julianne Cooley, senior statistician at the University. from California to Davis.

In the current study, the UC Davis team examined information from the California Cancer Registrywho collected information on cancer incidence and patient demographic, diagnostic, and treatment data since 1988. They first identified 12,442 women aged 21 and older with first primary cervical cancer. uterus was diagnosed in California between 2009 and 2018.

Nearly a fifth of the women on the register were over 65 (2,171 women). Of these, the majority were diagnosed with advanced disease (71%) compared to younger women (48%).

“And we saw that the 5-year overall survival of women over 65 was very low compared to younger women with cervical cancer,” Cooley said, referring to rates of survival from 23.2% to 36.8% for older women compared to 41.5% to 51.5% for women under 65.

The study also found that each increasing year of age was associated with a diagnosis of advanced cervical cancer. To capture the impact of patients’ comorbidities, the team used a modified Charlson comorbidity score, a weighted index of 16 comorbid conditions, not including cancer. In addition to age, factors associated with late-stage diagnosis included two or more comorbidities. Comorbidities increase with age and may lead to delayed diagnosis due to distraction from other health conditions, the authors wrote, and poorer survival may also result from less aggressive treatments in women over 65. .

Their analysis revealed that other influences, such as year of diagnosis, marital status, health insurance, neighborhood socioeconomic status, and urbanity, were not found to be significantly associated with breast cancer. cervix at an advanced stage.

According to Cooley, previous studies of younger women found an increase in late-stage cervical cancer diagnoses in younger Hispanic/Latin and black women, but this study found that Hispanic/Latin women older were less likely than non-Hispanic white women to be diagnosed late. -to organise.

“Because women are not getting screened as they should with Pap and/or HPV tests, this leaves many women vulnerable to a diagnosis of cervical cancer,” Cooley said, “And the proportion The number of women who do not get tested as they should increases as women age, so many women stop getting tested at age 65, but they had a sufficient history of regular testing. study by Boston University researchers found that up to 58% of women aged 64 to 66 in a national database did not meet screening discharge criteria.

The authors of the article point out that caregivers should focus on the women’s screening history to see if they were screened or if they followed up with abnormal test results.

“We know that cervical cancer is preventable through screening and can detect stage 1 cancer which has excellent survival,” added Cooley, who recommends that if a woman is over 65 years old and doesn’t know if she meets the discharge criteria for testing—or she’s pretty sure she didn’t—to get a catch-up test.

Outside of the United States, less intrusive methods of HPV testing, such as urine collection or vaginal self-swabs, have been shown to be accurate and a good alternative to speculum-based exams. Says Cooley, “If this were widely available in the United States, it is possible that more women would adhere to the selection criteria.”