Should the Exit Age for Cervical Cancer Screening Be Extended?

New estimates for cervical cancer rates proved higher than previously reported, especially among older women, when researchers accounted for hysterectomy prevalence.

The findings, published online in the American Cancer Society’s journal Cancer, included an increase in the overall incidence of cervical cancer, from 11.7 cases per 100,000 women to 18.6 per 100,000 women, when correcting the data for women who had undergone hysterectomies. 

Pertinent Points

- Cervical cancer rates are higher than previously estimated.

- The corrected rates suggest that cervical cancer rates peak at 27.4 cases per 100,000 women among women aged 65 to 69 years.

- To correct the incidence rates, researchers excluded women who had had hysterectomies. Previous calculations did not take that step.

Previous estimates of the disease included women who had had a hysterectomy, skewing previously reported rates, the authors noted. Once the uterine cervix is removed, however, these women are no longer at risk and should not be included in the at-risk group.

“In order to make accurate estimate of the true rates of cervical cancer by in the United States and monitor trends in the occurrence of disease, it is important to calculate the occurrence of cervical cancer only among women who are at risk,” explained Anne Rositch, PhD, of the University of Maryland School of Medicine, Baltimore, in a news release.

Furthermore, the authors discovered that the incidence of cervical cancer continues to increase with age, with women aged 65 to 69 years experiencing the highest incidence at 27.4 cases per 100,000 women. Previous uncorrected reports had suggested that the rate of disease peaked at 15.6 cases per 100,000 women among women aged 40 to 44 years.

Considering the results, the authors concluded that screening guidelines may need to be reconsidered, with particular attention given to determining at what age to stop screening.

“Current guidelines recommend exiting women with recent negative screening from routine screening at age 65 years, and yet our corrected calculations show that women just past this age have the highest rate of cervical cancer,” said senior author Patti Gravitt, PhD, of the Johns Hopkins Bloomberg School of Public Health, in a news release.

Researchers used estimates of hysterectomy prevalence from the Behavioral Risk Factor Surveillance System from 2000 to 2009 to correct the incidence rate of cervical cancer.

The corrected data also indicated that the rates of disease in black women were much higher than previously reported. Future studies are needed to determine whether the increased rates in black women indicate a failure in the screening programs, the authors noted.