A link between routine Pap smear screening and a lower risk of developing cervical cancer in women older than 65 years was confirmed in a recent study. Yet, most US health guidelines discourage women in that age group from receiving routine Pap smears unless they have pre-existing risk factors.1
“Some studies report that Pap smears are unnecessary in older age, while others show that there is a benefit in the over-65 age group,” said Karin Rosenblatt, PhD, a cancer epidemiologist and a professor of kinesiology and community health at the University of Illinois Urbana-Champaign. “There’s been a great debate about it.”
Although early research on screenings for cervical cancer recommended not testing after age 50 years, more recent studies have led to increasing the suggested age cutoff for screening due to better understanding of the disease and its risk factors.
The incidence of cervical cancer is greater in adult women younger than 65 years, Rosenblatt explained; however, women older than 65 years tend to have more fatal cases of the disease.
Pre-malignant cervical cancer tissue that is detected early, often through a Pap test, can be removed or treated so it does not progress into malignant cancer.
This study examined Medicare billing data from 1991 to 1999 and extracted information for more than 1200 women with recently diagnosed cervical cancer, as well as a group of more than 10,000 patients who had no cancer diagnosis. The researchers determined which patients had undergone a screening Pap smear 2 to 7 years prior to diagnosis.
“We found that the newly diagnosed cervical cancer group was less likely to have had a Pap smear, compared with the control group,” Rosenblatt said.
Rosenblatt stated that a more thorough cost-benefit analysis of conducting Pap smears in elderly women is needed. Although there is a clear benefit of diagnosing cervical cancer, for some groups such as those with short life expectancy or comorbid illnesses, screenings may be unnecessarily invasive.
“There needs to be further study of the benefits and risks of doing Pap smears in the elderly,” Rosenblatt said. Future studies should comprehensively assess cervical cancer screenings in older women and more accurately inform health policy recommendations.
1. Rosenblatt KA, Osterbur EF, Douglas JA. Case-control study of cervical cancer and gynecologic screening: a SEER-Medicare analysis. Gynecol Oncol. 2016 Jul 4. doi:10.1016/j.ygyno.2016.06.016. [Epub ahead of print]