Cervical cancer study suggests extended screening might be necessary
Rates of cervical cancer in the United States have been greatly underestimated, especially among women in their 60s and black women, according to a new study in the journal Cancer.
Previous estimates of cervical cancer put the rate of the disease at about 12 cases per 100,000 women. The highest rates were in women age 40 to 44, and then the rates leveled off. However, the new study concludes that rates are closer to 18.6 cases per 100,000 women when excluding women who have had hysterectomies.
The figures adjusted to account for hysterectomies show that the rates of cervical cancer peak around age 65 – when screening stops. They also found that African-American women had much higher rates of cervical cancer.
"I think it indicates that doctors need to discuss the risk versus benefits of continuing routine pap and HPV screening in women when they reach age 65," said Robert Morgan, M.D., co-director of the gynecological cancer program at City of Hope, who was not involved in the new study.
"It also points out the continuing need to provide medical services to minority populations in order to detect this illness in its premalignant state so that curative treatment is possible," he said. "This approach should be very cost effective, because treatment of cervical cancer after it is invasive requires intensive costly therapy, and metastatic cervical cancer is a devastating illness causing severe morbidity and very costly treatment."
Rather than leveling off among women in their 40s, the cervical cancer rate steadily climbs with age and peaks at ages 65 to 69, the study found. The incidence of cervical cancer among women in that age group was 84 percent higher than previously reported, according to the new study. (Women who have had a hysterectomy in which the cervix was removed are no longer at risk for cervical cancer.)
The new data show that cervical cancer peaks just at the age when current guidelines state regular screening can stop for many women.
The study also found a disparity among cancer rates between black women and white women. Black women had higher cervical cancer rates at nearly all ages than white women, and the difference was greatest among women ages 65 to 69. The rate among black women in this group was more than twice of what it is for white women.
Researchers from the University of Maryland School of Medicine who wrote the new report say further study is necessary to determine whether the rise in cervical cancer rates with age and the higher rates among black women are due to a failure in the current screening program or if women are not being screened so that appropriate interventions can be provided. The researchers also stressed the need for more use of the HPV vaccine, as the virus is responsible for a majority of cervical cancers.
Learn more about cervical cancer treatment at City of Hope.