Statistically controlling for hysterectomies revealed that cervical cancer rates are higher among women older than 65, according to research presented at the 2018 Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer, held March 24-27 in New Orleans, Louisiana.
The findings suggest that screening guidelines need to be reconsidered with an aging US population, said study co-author Sarah Dilley, MD, of the University of Alabama at Birmingham.
“Twenty percent of women with cervical cancer are diagnosed after age 65 and incidence rates increase with age when rates of hysterectomy are taken into account,” said Dilley.
Current guidelines recommend ending cervical cancer screening after age 65. But, as the baby boomer generation ages, those women will become a larger proportion of the general population. The US Census Bureau predicts that by the year 2030, 20% of women will be older than 65, up from 15% in 2016.
The study authors sought to confirm the cervical cancer burden among older women while calculating differences in cervical cancer by age and race.
“We hypothesized that there is a clinically significant number of women diagnosed with cervical cancer after age 65,” said Dilley.
The researchers analyzed data from two cancer databases, the National Cancer Database (NCDB) which contains information for more than 1,450 hospitals and captures data for approximately 70% of newly diagnosed cancers; and the National Cancer Institute’s Surveillance, Epidemiology and End Results (NCI-SEER) database, which congregates information from 18 population-level registries in 13 states, representing about 28% of the US population.
Using survey-weighted estimates of hysterectomies by age from the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System, they calculated age- and race-specific cervical cancer rates for both the NCDB and SEER data.
The team found that 18.9% and 19.7% of patients were diagnosed after age 65. Age-specific incidence rates climbed for women older than 40 years after correcting for hysterectomy, and peaked after age 70.
There was a pronounced racial disparity in the age-associated increase, with African-American women’s hysterectomy-corrected cervical cancer rates increasing much more dramatically with age than that of white women (P < .01).
“When stratified by race, a higher proportion of non-Hispanic black women are diagnosed after age 65 compared to other groups,” said Dilley
Data from the SEER and hospital-based NCDB cannot be directly compared because of their different patient populations, she cautioned. But the similarity of findings for both datasets bolstered her confidence in the team’s findings.
Dilley called for support for novel screening methods to reduce the number of women who are currently missed in screening programs and consideration of modification of existing screening guidelines to incorporate women older than 65.