A study published this week in PLOS Medicine suggests that screening women for cervical cancer beyond age 50 clearly saves lives, and also that there are benefits for women with normal (negative) screening results to continue screening up to the age of 69 years.
Peter Sasieni and colleagues, from Queen Mary University of London, UK, examined the link between screening women aged 50 to 64 for cervical cancer and cervical cancer diagnosed at ages 65 to 83. Their study included all 65 to 83-year old women in England and Wales diagnosed with cervical cancer between 2007 and 2012, a total of 1,341 women.
Women who had not been screened past age 50 had a 6 fold higher risk of being diagnosed with cervical cancer than those with adequate negative screening history at ages 50-64 -- 49 versus 8 cancers per 10,000 women over a period of 20 years. Women who had been screened regularly but had had a positive (abnormal) screening result between 50 and 64 had a risk of 86 per 10,000 women over 20 years.
Although these findings may not be generalizable to other settings and cervical screening methods are changing (with the availability of testing for Human Papilloma Virus), they suggest that cervical screening in women aged 50-64 y has a substantial impact on cervical cancer rates not only at age 50-64 y, but for many years thereafter.
The authors say: "Screening up to age 65 years greatly reduces the risk of cervical cancer in the following decade, but the protection weakens with time and is substantially less 15 y after the last screen. In the light of increasing life expectancy, it would seem inappropriate for countries that currently stop screening between the ages 60 and 69 years to consider reducing the age at which screening ceases."
In an accompanying Perspective, Anne Rositch, from the University of Maryland School of Medicine, USA, and colleagues say: "Incorporating the new data on older women, such as those… presented by Sasieni and colleagues, into the evaluation of whether to extend screening beyond age 65 for women with adequate negative screening will provide much needed insight into whether current guidelines are sufficient for the population now and in the future."
- Alejandra Castaρσn, Rebecca Landy, Jack Cuzick, Peter Sasieni. Cervical Screening at Age 50–64 Years and the Risk of Cervical Cancer at Age 65 Years and Older: Population-Based Case Control Study. PLoS Medicine, 2014; 11 (1): e1001585 DOI: 10.1371/journal.pmed.1001585
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