Should Women Over 65 Be Screened for Cervical Cancer?

By Kathy Hubbard

Most of us have been told that once we’ve reached the age of 65, if all of our screenings have been negative, that we no longer have to have Pap tests. You know, the one that can detect cervical cancer, which, although not painful, is just a bit, well, uncomfortable.

But, I just came across a study that was published in the American Journal of Preventive Medicine that states that “adjusted rates for cervical cancer do not decline until age 85, signaling a need for ongoing surveillance.”

Wow. Do we all need to rush to make an appointment with our primary care providers? Maybe, maybe not. You see, cervical cancer is most often thought of as a disease that affects young women. With that in mind, many older women fail to keep up with their regular screenings, which can accurately assess their risk.

“An older woman who has not had her cervix surgically removed has the same or even higher risk of developing cervical cancer compared to a younger woman,” said lead investigator Mary C. White, ScD, Chief of the Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention.

In 2013, when the study was completed, one-fifth of cervical cancer cases and one-third of cervical cancer deaths occurred among women 65 years of age and older.

“Using data from the 2013 and 2015 National Health Interview Survey (NHIS), investigators looked at the use of screening tests and rates of cervical cancer for women 65 years of age and older. They found that when corrected for hysterectomy, incidence rates of cervical cancer increased with age until 70 and did not begin to decline until age 85,” the AJPM article said.

“Premature discontinuation of routine screening among women in the years before age 65 could contribute to preventable cases of invasive cervical cancer and deaths,” Dr. White said. “In the short term, efforts could be undertaken to clarify misperceptions about the risk of cervical cancer among older women and providers. Messages about a ‘stopping age’ need to emphasize the recommendation for an adequate screening history of previous negative tests before screening is discontinued, not just chronologic age.”

So when should women be tested? The American Cancer Society says that all women should begin cervical cancer testing at age 21 and repeated every three years. At age 30, the Pap test should be combined with an HPV test every five years and continue until age 65.

“Women at high risk of cervical cancer because of a suppressed immune system (for example from HIV infection, organ transplant, or long-term steroid use) or because they were exposed to DES (synthetic estrogen) in utero may need to be screened more often,” ACS says.

They also say that some women think they can stop cervical cancer screening when they stop having children, and that’s not at all true.

Cervical cancer was once the leading cause of cancer deaths for American women. Thanks to Pap testing, which started in the 1940s, the death rate has been reduced significantly. However, the ACS says that the death rate hasn’t changed much in the last 15 years.

ACS estimated that about 13,170 new cases of invasive cervical cancer cases would occur in 2019 and that around 4,250 women would die from it. The actual numbers haven’t been released yet.

Women at high risk include those infected by the human papillomavirus (we’ve talked about vaccines before) or the common sexually transmitted disease, chlamydia. Women who smoke are twice as likely as non-smokers to get cervical cancer. Being overweight or eating a diet low in fruits and vegetables can increase your risk as can long-term use of oral contraceptives.

And, of course, cervical cancer can run in your family. The best defense is to get regular Pap tests, which can determine if there are any pre-cancerous or cancerous cells.

As I said already, it’s time to talk to your primary care provider to do the right thing for your body and age. If you don’t have a PCP, Sandpoint Women’s Health is accepting new patients; you can call them at 208-263-2173 for an appointment.

 

Kathy Hubbard is a member of Bonner General Health Foundation Advisory Council. She can be reached at [email protected].

 

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