Objective.
To review the literature on the role of cervical cancer screening in women aged 60 years and older.
Methods.
The literature was reviewed using PubMed and the search terms: cervical flab, cervical cancer, middle-aged, older, postmenopausal, cervical cytology, and screening. The included articles must be in English. The review focused on the literature from 2000 onwards.
Results.
All case-control and simulation studies discussing the role of cervical cancer screening in women aged 60 years and older were reviewed. Outcomes of interest included.
(1) Benefits in terms of screening-related reductions in cervical cancer incidence (6 studies) and mortality (3 studies);
(2) duration of protection in the last screening trial (4 studies);
(3) harms of screening older women, including false-positive test results and costs.
CONCLUSIONS.
Cervical cytology screening is beneficial in preventing the development of cervical cancer and death from cervical cancer in women over 60 years of age. A negative cytology test provides 5 years of protection in this age group. The maximum age for an organized screening program may vary depending on goals and individual desires.
I. Introduction
In 2012, Saslow published guidelines from the American Cancer Society (ACS), the American Society for Colposcopy and Cervical Pathology (ASCCP), and the American Society for Clinical Pathology and Screening (ASCPSG) recommending a cutoff date for cervical cancer screening of 65 years if there have been three normal cytologic screens in the preceding 10 years or more. Patients who do not meet these criteria need to continue to be screened.
Because there are no randomized clinical trials of screening, these guidelines are based on consensus after reviewing a limited number of retrospective studies and one simulation study. In this article, we will review the arguments in support of this recommendation and the controversies surrounding concerns about this recommendation.
II. METHODS
PubMed was used to review the literature from 2000 to 2014. Search terms included cervical cancer (cervical cancer tumor and cancer), screening (cytology), and older age (elderly, postmenopausal, older, and older). The types of studies of interest were case-control, cohort studies, or randomized controlled trials.
III. Results
We will start by looking at the questions asked about the new guidelines. The incidence of cervical cancer in women of all age groups showed a bimodal distribution of new cases in the age groups 30 to 39 and 60 to 69 years. Of all new cervical cancers, 20% occurred in women aged 65 years and older, and these women accounted for 34% of cervical cancer-related deaths.
Therefore, if screening reduces the risk of cervical cancer, but 60 to 69 years is also the peak incidence of cervical cancer, it may be that there is a group of women who are not screened or who get screened. Either there is a problem with the accuracy of screening or there are other reasons to explain the high incidence of cervical cancer in women aged 60 years and older.
We know that the incidence of cervical cancer is highest in women who have never been screened. Never screened or less screened women comprise 40% of cervical cancer cases. Therefore, regardless of age, never screened or less screened women need to be screened. However, 60% of women with cervical cancer have been screened.
Not only does cervical cancer occur more frequently in middle-aged and older women, but it also has a higher mortality rate compared to younger women. First, older patients tend to present with more advanced cervical cancer and have a lower 5-year survival rate for advanced stages compared to early stage cervical cancer. Older women who are not screened will exhibit symptoms similar to vaginal bleeding or malignant discharge. Symptoms usually appear at a later stage, while early stage lesions are usually asymptomatic. In addition, older women may have an immune deficiency, which leads to a poorer prognosis.