CERVICAL CANCER: Overscreening in older women?

CERVICAL CANCER: Overscreening in older women?

“Cervical cancer screening and other preventative procedures are exceedingly important in promoting healthy aging, however screenings must follow evidence-based guidelines to avoid overspending, possible complications with overdiagnosis and overtreatment as well as to preserve patients’ quality of life,” says one of the authors, Dr. Hunter Holt, professor of family and community medicine at the University of Illinois at Chicago.

“Cancer screening relies on a careful risk-benefit analysis,” says another author, Dr. George Sawaya, professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco.

Uncertain clinical relevance?

Guiding lines : According to the recommendations of the US Preventive Services Task Force, the American Cancer Society and the American College of Obstetrics and Gynecology, women considered to be at average risk can stop having this routine screening for cervical cancer. uterus once they have reached the age of 65 if they have had regular and normal pre-screenings.

However, there is still a need to regularly review this decision to end cervical cancer screening after age 65. The researchers point out in particular that the high rates of screening among older women are concerning: “It may be that many women are being tested when they do not need it, or that these women are considered to be at higher risk. average, for example, because they were not sufficiently screened before the age of 65”.

The study looked at health insurance claims data from 1999 to 2019 for care for women aged 65 and older. The analysis reveals valuable data:

  • in 2019, more than 1.3 million women over the age of 65 had cervical cancer screening, such as a Pap test, colposcopy and other cervical procedures;
  • thus, about 3% of women over the age of 80 received at least one procedure related to screening – which could suggest “over-screening”, write the authors;
  • white women were more likely to be screened after age 65;
  • the Pap test rate among women over 65 fell from 19% (2.9 million women) in 1999 to 9% (1.3 million women) in 2019, a reduction of 55%;
  • colposcopy and cervical surgery rates decreased by 43% and 64%, respectively;
  • however, women over 65 still account for approximately 20% of cervical cancer diagnoses and 36% of deaths.

These experts therefore do not decide on the advisability of reviewing the guidelines for cervical cancer screening. Their analysis again underscores the importance of regular screening up to age 65, suggesting that many cases diagnosed beyond this age may be correlated with poor compliance with screening, both earlier and throughout life. life.

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