Age Cutoff for Pap Tests Questioned

Analysis of a National Cancer Institute (NCI) database suggests that using age 70 as the cutoff for cervical cancer screening might omit women who account for a growing proportion of the at-risk population. More than 12% of newly diagnosed cervical cancers occurred in women aged 70 to 85 years during 2000 to 2006. The rate was similar to the incidence in younger women who are more often associated with the cancer. Among older women, about 60% of cervical cancer diagnoses occurred at later disease stages, which have fewer treatment options.

“On the basis of these findings, it is fair to ask whether the current screening schedule for cervical cancer is contributing to the cervical cancer distribution pattern,” said Malgorzata E. Skaznik-Wikiel, MD, an oncologist at Magee-Womens Hospital in Pittsburgh, Pennsylvania. “The findings also question whether we need a more structured cervical cancer screening program for women over the age of 70.”

Skaznik-Wikiel made the comments during a presentation at the recent Society of Gynecologic Oncologists meeting in Orlando, Florida.

Current clinical guidelines recommend discontinuation of cervical cancer screening with Pap tests in women aged >65 years who meet certain criteria: 3 consecutive normal Pap tests, no history of abnormal tests in the past 10 years, and no history of cervical dysplasia or neoplasia.

To examine the recommendations within the context of contemporary epidemiologic trends, Skaznik-Wikiel and colleagues analyzed data from the NCI Surveillance, Epidemiology and End Results (SEER) program. They found that women aged 70 to 85 years accounted for 12.18% of the 18,000 new cases of cervical cancer during 2000 to 2006. The percentage was similar to the rates of 12.55% to 14.99% among women aged 35 to 49 years.

The stage distribution of cervical cancer varied between older and younger women. Among women aged <30 years, stage IA1 was most common (38%) and stage IA1-IB comprised three-quarters of all cases. In contrast, stage IIIB was most common among women aged >69 years (19%), and advanced stages (IIB-IVB) accounted for 59% of all diagnoses in that age group.

Skaznik-Wikiel said that several factors, which conspire to create an age-incidence disparity, confound current cervical cancer screening recommendations for older women:

• Inaccurate results (both false-positive and falsenegative), which are more likely in older women because of sampling issues and because of age-related cellular changes that resemble neoplasia
• The changing epidemiology of human papillomavirus (HPV) infection, whose rates of infection decline in women aged 30 to 70 years but then begin to increase
• The growing population of older women

“Women older than 65 account for 13% of the US population but 25% of new cervical cancer diagnoses,” said Skaznik-Wikiel.