Cervical Cancer Risk Overlooked After Age 65
Analysis of over 2.1 million women in China revealed that those aged 65 years or older vs those younger than 65 years had significantly higher rates of high-risk human papillomavirus (hr-HPV) infection (13.67% vs 8.08%) and cervical cancer (0.092% vs 0.01%) although most guidelines recommend discontinuing screening for women aged 65 years or older with a normal screening history.
METHODOLOGY:
Researchers conducted a retrospective analysis of cervical cancer screening data from Shenzhen, China (2017-2023), to assess hr-HPV distribution and cervical intraepithelial neoplasia grade 2 or worse (CIN2+) prevalence in women aged 65 years or older vs those younger than 65 years.
Data collection encompassed 628 healthcare facilities, including 496 community health centers, 94 hospitals, 11 maternal and child health hospitals, and 27 other medical facilities.
Clinical records included demographic information, cytology results, HPV testing covering 14 hr-HPV genotypes (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68), and colposcopy/biopsy outcomes.
Analysis included 2,152,766 complete records from an initial collection of 2,580,829, yielding an 83.4% data validity rate.
TAKEAWAY:
Analysis of 2,152,766 records revealed that women aged 65 years or older (n = 17,420; 0.81%) vs those younger than 65 years showed higher hr-HPV prevalence (13.67% vs 8.08%), CIN2+ detection rate (0.333% vs 0.155%), and cancer rate (0.092% vs 0.01%; P for all < .001).
Single, double, and triple hr-HPV infections were found in 10.56%, 2.32%, and 0.57% of women aged 65 years or older, with CIN2+ detection rates of 2.01%, 2.73%, and 4.04%, respectively, all exceeding rates in those younger than 65 years (P < .001).
A significant dose-response relationship emerged between hr-HPV infections and CIN2+ risk in women aged 65 years or older (P for trend < .001), with odds ratios being 55.86 (95% CI, 21.81-143.07), 65.95 (95% CI, 22.63-192.18), and 85.45 (95% CI, 24.15-302.35) for single, double, and triple infections, respectively.
IN PRACTICE:
'Currently, there is a significant global gap in cervical cancer prevention for older women, and urgent action is needed. First, screening and early diagnosis for women aged ≥ 65 should be strengthened, including affordable screening services and age-appropriate technologies to detect and treat precancerous lesions. Additionally, community engagement, health education, and media campaigns can raise awareness of cervical cancer risks and prevention among older women, encouraging active participation in screening programs,' authors of the study wrote.
SOURCE:
The study was led by Zichen Ye, He Wang, and Yingyu Zhong, who served as joint first authors. It was published online in Gynecology and Obstetrics Clinical Medicine.
LIMITATIONS:
The study faced several limitations despite using high-quality, large-sample, real-world cervical cancer screening data collected over 7 years in Shenzhen. Because women aged 65 years or older were not included in the national target screening population, participants may have had symptoms or concerns, introducing potential selection bias. The low number of hr-HPV infections in this age group led to some results trending toward extremes, affecting result stability. Additionally, data from a single region in China limited generalizability to other populations. The researchers could not obtain specific information about the types of cytologic detection products and HPV genotyping products used, which may have affected result precision and comparability.
DISCLOSURES:
The study was supported by the Sanming Project of Medicine in Shenzhen (SZSM202211032). The authors reported having no relevant conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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