Advertisement

Cervical Cancer Screening and Incidence by Age: Unmet Needs Near and After the Stopping Age for Screening

  • Mary C. White
    Correspondence
    Address correspondence to: Mary C. White, ScD, Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, CDC, 4770 Buford Highway, MS F76, Atlanta GA 30341
    Affiliations
    Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
    Search for articles by this author
  • Meredith L. Shoemaker
    Affiliations
    Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
    Search for articles by this author
  • Vicki B. Benard
    Affiliations
    Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
    Search for articles by this author

      Introduction

      Leading professional organizations recommend cervical cancer screening for average-risk women aged 21–65 years. For average-risk women aged >65 years, routine screening may be discontinued if “adequate” screening with negative results is documented. Screening is recommended after age 65 years for women who do not meet adequate prior screening criteria or are at special risk.

      Methods

      Authors examined the most recent cervical cancer incidence data from two federal cancer surveillance programs for all women by age and race, corrected for hysterectomy status. The 2013 and 2015 National Health Interview Surveys were analyzed in 2016 to examine the proportion of women aged 41–70 years without a hysterectomy who reported that they never had a Pap test or that their most recent Pap test was >5 years ago (not recently screened).

      Results

      The incidence rate for cervical cancer among older women, corrected for hysterectomy status, did not decline until age ≥85 years. The proportion not recently screened increased with age, from 12.1% for women aged 41–45 years to 18.4% for women aged 61–65 years.

      Conclusions

      Even among women within the recommended age range for routine screening, many are not up to date, and a substantial number of women approach the “stopping” age for cervical cancer screening without an adequate prior screening history. Efforts are needed to reach women who have not been adequately screened, including women aged >65 years, to prevent invasive cervical cancer cases and deaths among older women.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • U.S. Cancer Statistics Working Group
        United States Cancer Statistics: 1999–2013 Incidence and Mortality Web-based Report.
        U.S. DHHS, CDC, and National Cancer Institute, Atlanta, GA2016
        • Kamineni A.
        • Weinmann S.
        • Shy K.K.
        • Glass A.G.
        • Weiss N.S.
        Efficacy of screening in preventing cervical cancer among older women.
        Cancer Causes Control. 2013; 24: 1653-1660https://doi.org/10.1007/s10552-013-0239-4
        • Rustagi A.S.
        • Kamineni A.
        • Weinmann S.
        • Reed S.D.
        • Newcomb P.
        • Weiss N.S.
        Cervical screening and cervical cancer death among older women: a population-based, case-control study.
        Am J Epidemiol. 2014; 179: 1107-1114https://doi.org/10.1093/aje/kwu035
        • American College of Obstetricians and Gynecologists
        ACOG Practice Bulletin No. 157. Cervical Cancer Screening and Prevention.
        Obstet Gynecol. 2016; 127: e1-e20https://doi.org/10.1097/AOG.0000000000001263
        • Moyer V.A.
        Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement.
        Ann Intern Med. 2012; 156: 880-891https://doi.org/10.7326/0003-4819-156-12-201206190-00424
        • Saslow D.
        • Solomon D.
        • Lawson H.W.
        • et al.
        American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer.
        CA Cancer J Clin. 2012; 62: 147-172https://doi.org/10.3322/caac.21139
        • Castanon A.
        • Landy R.
        • Cuzick J.
        • Sasieni P.
        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 Med. 2014; 11: e1001585https://doi.org/10.1371/journal.pmed.1001585
        • National Center for Health Statistics
        Survey Description, National Health Interview Survey, 2013.
        National Center for Health Statistic, Hyattsville, MD2014
      1. National Center for Health Statistics. Survey Description, National Health Interview Survey, 2015. Hyattsville, MD: National Center for Health Statistic; 2016.
        • Benard V.B.
        • Thomas C.C.
        • King J.
        • et al.
        Vital signs: cervical cancer incidence, mortality, and screening−United States, 2007–2012.
        MMWR Morb Mortal Wkly Rep. 2014; 63: 1004-1009
        • Benard V.
        • Royalty J.
        • Saraiya M.
        • Rockwell T.
        • Helsel W.
        The effectiveness of targeting never or rarely screened women in a national cervical cancer screening program for underserved women.
        Cancer Causes Control. 2015; 26: 713-719https://doi.org/10.1007/s10552-015-0542-3
        • Rositch A.F.
        • Nowak R.G.
        • Gravitt P.E.
        Increased age and race‐specific incidence of cervical cancer after correction for hysterectomy prevalence in the United States from 2000 to 2009.
        Cancer. 2014; 120: 2032-2038https://doi.org/10.1002/cncr.28548
        • Sherman S.M.
        • Castanon A.
        • Moss E.
        • Redman C.
        Cervical cancer is not just a young woman’s disease.
        BMJ. 2015; 350: h2729https://doi.org/10.1136/bmj.h2729
        • Cuzick J.
        • Myers O.
        • Hunt W.C.
        • et al.
        A population-based evaluation of cervical screening in the United States: 2008–2011.
        Cancer Epidemiol Biomarkers Prev. 2014; 23: 765-773https://doi.org/10.1158/1055-9965.EPI-13-0973
        • Elit L.
        Role of cervical screening in older women.
        Maturitas. 2014; 79: 413-420https://doi.org/10.1016/j.maturitas.2014.09.012
        • Brouwer A.F.
        • Eisenberg M.C.
        • Carey T.E.
        • Meza R.
        Trends in HPV cervical and seroprevalence and associations between oral and genital infection and serum antibodies in NHANES 2003–2012.
        BMC Infect Dis. 2015; 15: 1https://doi.org/10.1186/s12879-015-1314-0

      CHORUS Manuscript

      View Open Manuscript