Mary C. White, ScD, MPH
Many women within the recommended age for routine screening are not up to date on Pap tests. Even women who are approaching the age when they no longer need screening do not have an adequate prior screening history, according to Mary C. White, ScD, MPH.
The average woman at risk for cervical cancer ranges between 21 to 65 years old. When those women reach 65 or older, they are considered to be no longer at risk and can discontinue screening if they were consistently screened with negative results. However, women over 65 who did not meet adequate prior screening criteria are still recommended for screening.
In an analysis of the 2013 and 2015 National Health Interview Surveys, a proportion of women were examined between the ages of 41 to 70 years old without a hysterectomy who reported that they had never had a Pap test or their most recent test was more than 5 years previously.
“We found that an older woman who has not had her cervix surgically removed has the same or even higher risk of developing cervical cancer as she ages compared to a younger woman,” explains White.
The proportion of women analyzed who were not recently screened increased with age, from 12.1% for women 41 to 45 years old to 18.4% for women who were 61 to 65 years old.
“It's important to reach out to women who have not had a hysterectomy and who have not been screened for many years, including many older women, to prevent cases of and deaths from cervical cancer,” states White.
In an interview with OncLive,
White, an epidemiologist at the Centers for Disease Control and Prevention (CDC), discussed the unmet needs near and after the stopping age for cervical cancer screening.
OncLive: Can you provide an overview of this research and the rationale behind it?
The CDC collects surveillance data both in terms of cancer incidence and health behaviors, such as screening. In this study, we used data from 2 federal cancer registry programs to examine how cervical cancer risk changes with age, after excluding women who have had a hysterectomy. Hysterectomy typically includes the removal of the cervix, meaning they are no longer at risk for cervical cancer.
We also looked at data from a federal national health survey to examine a proportion of women who have either never been tested for cervical cancer or had not been tested in the last 5 years.
The rationale behind conducting this research is that for women between the ages of 21 to 65, Pap testing every 3 years or Pap testing with HPV co-testing every 5 years, can prevent cervical cancer and deaths. No woman in this country should die of cervical cancer.
What were the most significant findings from this research?
Looking at the data on cervical cancer incidence, once we’ve adjusted the denominator by removing the estimated number of women who, at different ages, have already undergone a hysterectomy, we were able to discover what the adjusted cancer incidence was.
We found that an older woman who has not had her cervix surgically removed has the same or even higher risk of developing cervical cancer as she ages compared to a younger woman.
We also found that a substantial number of women approach this stopping age for screening who have not been screened for many years. The current recommendation states that women aged 65 and over and not otherwise at special risk can skip Pap tests, but only if they have had 3 consecutive negative Pap screening tests or 2 consecutive negative co-tests over the past 10 years, with the most recent test done within the last 5 years.