Older Women May Not Get Needed Cervical Cancer Screenings

Background

One type of cancer that only women can get is cancer of the cervix, or cervical cancer. Most cervical cancer is caused by human papillomavirus (HPV). The only sure way to find out if you have cervical cancer is to get a screening test (a Pap test, an HPV test, or both tests). If you are a woman who has not had her cervix removed by surgery (a hysterectomy), keep getting tested until you are at least age 65.

However, a study found that some women do not continue to get screened for cervical cancer as they get closer to age 65. Unfortunately, you can still get cervical cancer when you are older than 65. The only way to know it is safe to stop being tested after age 65 is if you have had several tests in a row that didn't find cancer within the previous 10 years, including at least 1 test in the previous 5 years.

• For the Pap test alone, you should have 3 normal tests in a row.
• For the Pap-HPV co-test, you should have 2 normal tests in a row.
• Screening after age 65 may be appropriate for some women at high risk, including women with a history of cervical lesions or cancer, women whose mothers took a hormone called diethylstilbestrol (DES) while pregnant, or women who have a weakened immune system. Women at high risk should talk with their doctors about how often to get screened and when to stop being screened.

How the study worked

The researchers wanted to know how many women between ages 41 and 70 had never had a Pap test or co-test, or hadn't had one in the 5 years before the survey. They looked at answers to questions about cervical cancer testing in the National Health Interview Survey. The questions were asked in 2013 and 2015. The researchers also looked at information from two federal cancer registry programs to see how the chance of getting cervical cancer changes with age among women who have not had a hysterectomy. (Cancer registries are used to keep detailed records about cases of cancer.)

Key findings

• The older women get, the more likely it is that they have never been tested or haven't been tested in the previous 5 years.
• About one woman out of 20 between ages 66 and 70 has never been tested.
• An older woman, until she's in her 80s, who has not had a hysterectomy, is at least as likely to get cervical cancer as a younger woman.
• Cervical cancer incidence rates increased with age and were higher for Black women than White women.

What this means

• If you are a woman between 21 and 65 who hasn't had a hysterectomy and hasn't had a cervical cancer screening test in the past 5 years, ask your doctor about getting one.
• If you are a woman older than 65 who hasn't had a hysterectomy, talk to your doctor about your risk for cervical cancer and whether you still might benefit from testing.
• Health care staff, as part of regular checkups, could review the health records of patients 65 years or older, or ask about past cervical cancer screening tests before deciding it's safe to stop screening for cervical cancer.
• For all women between ages 21 and 65 with no recent history of cervical cancer screening, health care staff can counsel them about the importance of getting a screening test.

Data citation

White MC, Shoemaker ML, Benard VB. Cervical cancer screening and incidence by age: unmet needs near and after the stopping age for screening. Am J Prev Med. 2017;53(3):392–395.