New research presented this week is looking at cervical cancer screening and whether the guidelines, which recommend against testing women over 65, may need a refresh.
It's a feeling with which some cervical cancer survivors agree.
"I talk to friends and tell them to get screened. I have a friend whose doctor very adamantly said she doesn’t need to worry about it," Barbara Willey, 72, of Louisville, Kentucky, said. "I tell her, if my cancer hadn’t been caught by the time I was 70, I might not be around right now to enjoy everything I have, like time with my grandkids."
Current guidelines say that women between 21 and 65 years of age should be tested for cervical cancer, whether by pap smear or human papilloma virus (HPV) testing -- since the HPV virus is responsible for nearly all cases of cervical cancer. The recommendation was set by the U.S. Preventive Services Task Force (USPSTF), which works to improve the health of Americans by making evidence-based recommendations about preventive treatments and testing.
This is their “Grade A” recommendation, meaning “there is high certainty that the net benefit is substantial.”
Practicing doctors tend to take their advice, also because their stamp of approval means that the cost for testing must be covered by health insurance.
For women under 21 and over 65, they "discourage the use of this service" for clinical practice. This means the USPSTF believes the net benefit does not outweigh the harms of testing —- so cervical cancer tests for women over 65 have earned a “Grade D” recommendation.
The Department of Obstetrics and Gynecology at the University of Alabama, however, just presented new research with a different view. At the 49th Society for Gynecologic Oncology Annual Meeting in New Orleans this week, they suggested rethinking the guidelines.
"What is interesting is that even though incidence rates are going down, we found that the absolute number of cancer cases is not significantly decreasing in women who are age 65 or over. We hypothesize that this is because the overall number of women in this age group is increasing," study author Dr. Sarah Dilley, a gynecologic oncology fellow at the University of Alabama at Birmingham, said.
The researchers looked at data on cervical cancer diagnoses from two highly-respected cancer registries—SEER (Surveillance, Epidemiology and End Results) and NCDB (National Cancer Database).
According to SEER, cervical cancer cases have declined from 2000-2014 in people between 20-49, as well as those over 75. But, alarmingly, about 20 percent of 10,000 cases were in women over 65—that’s about 1 in every 5 cervical cancer diagnoses.
The NCDB data from 2004-2014 is similar: 19 percent of about 20,000 cervical cancer cases were in women over 65. And the cases in those over 65 were fairly evenly distributed across ethnicities. The highest proportion were seen in African Americans, roughly 22 percent, but other ethnic groups were not far behind —- about 20 percent in whites, 14 percent in Hispanics and 21 percent in “other” ethnic groups.
The authors are suggesting that the USPSTF and other professional societies reconsider screening age limits, because it could potentially improve outcomes —- and save lives in an expanding age group.
"As life expectancy increases, this is a population that is growing," Dilley said. "Extending screening may help improve this and should certainly be considered. But I think that additional research and thought will need to be put into this issue before that recommendation can officially be made."
Najibah Rehman, M.D., M.P.H., is a third-year preventive medicine resident at the University of Michigan working in the ABC News Medical Unit.