What to know
In 2019, more than 1.3 million women age 65 or older who were covered by Medicare received cervical cancer screening and associated services, at a cost of more than $83 million.
Background
The US Preventive Services Task Force (USPSTF) recommends against screening for cervical cancer in women who are older than 65, are not at high risk for cervical cancer, and have had normal cervical cancer screening test results for several years.
CDC scientists wanted to know if older women were receiving cervical cancer screening tests and associated services, and if this had changed over time. So they looked at Medicare fee-for-service claims data from 1999 to 2019.
Key findings
About 15 to 16 million women who were 65 or older had Medicare fee-for-service coverage each year from 1999 to 2019. In this group:
- Pap tests were the most common tests used to screen for cervical cancer. In 1999, nearly 100% of cervical cancer screening tests were Pap tests. In 2019, Pap tests made up about 83% of cervical cancer screening tests; Pap tests and human papillomavirus (HPV) tests together (co-testing) made up about 15% of tests; and HPV tests alone made up 1% of tests.
- The number of women who were screened for cervical cancer dropped from about 2.9 million in 1999 to 1.3 million in 2019.
- In 1999, 29% of cervical cancer screening tests were given to women who were age 65 to 69 years and 17% were given to women 80 or older. In 2019, 41% of tests were given to women who were 65 to 69 and 10% to women 80 or older.
- During all years of the study, non-Hispanic White women had the highest cervical cancer screening test use and non-Hispanic American Indian and Alaska Native women had the lowest.
- Hispanic women and non-Hispanic Black women had higher colposcopy use than non-Hispanic White women during all years of the study. A colposcopy is a follow-up test given if a cervical cancer screening test result is abnormal. A doctor looks closely at a woman's cervix to see if there are abnormal cells that could lead to cancer.
- In 2019, Hispanic women, non-Hispanic American Indian or Alaska Native women, and non-Hispanic Black women had higher use of cervical procedures (loop electrosurgical excision procedure, cone biopsy, or ablation) than non-Hispanic White women.
- In 2019, Medicare paid about $84 million for all cervical cancer screening-associated services in women 65 or older. Of this total, Medicare paid about $76 million for screening tests.
- In 2019, Medicare paid about $7.4 million for all cervical cancer screening-associated services in women who were 80 or older.
What this means
Cervical cancer screening test use has been declining steadily since 1999 among women who are 65 or older and have Medicare fee-for-service coverage. Even so, in 2019, more than 8% of these women were screened for cervical cancer.
In 2019, about 41% of cervical cancer screening tests were given to women who were age 65 to 69 years. Many of these tests may have been done to meet the criteria to stop screening after age 65. Cervical cancer screening is recommended in women older than 65 if they haven't had several tests in a row that didn't find cancer within the previous 10 years, their screening history is unknown, or if they are at high risk.
The study showed that non-Hispanic Black women and Hispanic women were more likely to get a diagnostic colposcopy and cervical procedures than non-Hispanic White women. This means that precancerous lesions and cancer were found among non-Hispanic Black women and Hispanic women more often than among non-Hispanic White women. This could be because these women were not screened as recommended before they became eligible for Medicare.
Finding ways to give doctors access to patients' medical history, and educating doctors and patients about screening recommendations, could help reduce unnecessary screening tests among older women.
What women can do
If you are younger than 26, get an HPV vaccine if you haven’t had one already.
If you are 21 to 65, get screened for cervical cancer as recommended.
If you are older than 65, ask your doctor if you still need to be screened. You may still need to be screened after age 65 if you haven’t been screened regularly in the past 10 years or are at high risk for cervical cancer. You may be at high risk if you have a history of cervical lesions or cancer, your mother took a hormone called diethylstilbestrol (DES) while pregnant, or you have a weakened immune system.
What health care providers can do
- For patients who are older than 65: Review their medical records or ask about past cervical cancer screening tests before deciding it's safe to stop screening for cervical cancer.
- For patients who are 21 to 65: Explain the importance of being screened regularly for cervical cancer, and educate them about screening options.
Data citation
Qin J, Holt HK, Richards TB, Saraiya M, Sawaya GF. Use trends and recent expenditures for cervical cancer screening–associated services in Medicare fee-for-service beneficiaries older than 65 years. JAMA Intern Med. 2023;183(1):11–20.