Nearly one in five new cervical cancers diagnosed from 2009 to 2018 were in women 65 and older, according to a new UC Davis study. But what has experts concerned is that, according to the study, more older women (71%) had late-stage cancer than younger women (48%), which corresponds to lower survival rates that only get worse with age.
In general, if cervical cancer is diagnosed after it has spread to nearby tissues, organs or lymph nodes, the five-year relative survival rate is 59%, according to the National Cancer institute (NCI). However, the study found that the late-stage five-year relative survival rate was lower for women older than 65 — only 23.2% to 36.8% — compared with women under age 65 (41.5%–51.5%). (By comparison, when cervical cancer is diagnosed at an early stage, the five-year relative survival rate is 92%, per the NCI.)
Current screening guidelines from the American Cancer Society (ACS) recommend that individuals over 65 years old who have had cervical cancer screenings with normal results within the past 25 years and have tested negative in the 10-year period before age 65 should not be screened for cervical cancer. Once screening is stopped, note the guidelines, they should not be started again.
But, as this study lays bare, cervical cancer risk doesn’t simply go away at age 65.
Julianne Cooley, lead author of the study and senior statistician at UC Davis, tells Yahoo Life that the American Cancer Society predicts that 13,960 women in the U.S. will be diagnosed with cervical cancer in 2023, “and that 20% will be over 65,” she says.
Cooley says the study results are “extremely concerning” because “cervical cancer is preventable through screening, and no one should be dying of this disease.”
Dr. Connie Liu Trimble, professor of gynecology and obstetrics at Johns Hopkins Medicine, agrees, calling it a “travesty.” She tells Yahoo Life: “It shouldn’t happen in this day and age.”
So what can older women do to protect their health? Here’s what experts say.
First, what causes cervical cancer?
Almost all cervical cancers are caused by HPV (human papillomavirus), which is an extremely common virus. About 13 million Americans become infected with HPV each year, according to the Centers for Disease Control and Prevention (CDC).
HPV is spread through vaginal, anal and oral sex, as well as through skin-to-skin contact with the genitals of an infected person. “If you’ve had sex, you’ve been exposed to HPV — full stop,” says Trimble.
There are more than 200 types of HPV, including low-risk types that can cause genital warts, and 14 high-risk types (in particular, HPV16 and HPV18) that can cause several types of cancer — not just cervical cancer but also cancers of the vagina, vulva, penis, anus and back of the throat, according to the CDC.
In most cases, “the immune system can clear HPV, but the body's ability to do that reduces over time,” Dr. Renata Urban, a gynecologic oncologist at UW Medicine, tells Yahoo Life.
But in some cases, HPV persists over several years — a precancer can take “10 to 15 years to turn into cancer, if it’s going to do that,” says Trimble — causing abnormal changes in cervical cells that can lead to cancer.
Are current screening guidelines for older women falling short?
Although more than 20% of cervical cancer cases are found in women over 65, these cancers “rarely occur” in those who have been getting regular cervical cancer screenings before they were 65, Sarah Diemert, nurse practitioner and director of medical standards integration and evaluation for Planned Parenthood Federation of America, tells Yahoo Life.
Urban says because it can take a decade or more for HPV-infected cervical cells to turn into cancer, combined with the fact that there’s an increase in advanced-stage cervical cancer in this older age group, this “means females are not getting appropriate screening.” What is not clear is why — are patients not going to their doctor appointments and missing out on years of cervical cancer screenings, or are doctors not performing the screenings? Or do screenings need to be extended beyond age 65?
Cooley says her study results can’t determine if screening should continue after age 65 “because we did not have data on if the women over 65 who were diagnosed with cervical cancer were getting screened prior to turning 65.”
However, she says, “we do know that as many as 23% of women over age 18 are not up to date on cervical cancer screening and that many do not follow up on irregular screening results. Therefore it is possible that the screening guidelines are adequate, but older women did not follow screening guidelines prior to turning 65, leaving them vulnerable to late-stage cervical cancer diagnoses.”
Older women may also be underestimating their risk. Cervical cancer is most frequently diagnosed in women between the ages of 35 and 44, with the average age at diagnosis being 50, notes Diemert. “Many older women do not realize that the risk of developing cervical cancer is still present as they age,” she says.
How is late-stage cervical cancer treated?
Treatment is typically a combination of chemotherapy and radiation, as well as a specialized treatment called brachytherapy, in which the source of radiation is placed inside the vagina, according to ACS.
However, Trimble says that it can be “really difficult” to treat late-stage cervical cancer, particularly in older patients. Urban points out that, as patients age, “they may have higher rates of hypertension or diabetes, which can affect kidney function and that may affect their ability to receive the most common type of chemotherapy that’s given with radiation. In addition, some of the side effects can include loose stools or diarrhea but older women may be much more susceptible to dehydration and fatigue,” so these side effects may hit them harder.
What can older women do to protect their health?
“These study results reinforce the need for anyone with a cervix to get regular cervical cancer screening and other types of cancer screenings,” Diemert says.
For Cooley, she says it’s important to determine if women have met the screening guidelines prior to turning 65 before regular screening is stopped. “If older women were not getting screened regularly before turning 65, they should schedule a catch-up test as soon as possible,” she says. Trimble adds that if your primary care physician doesn't or won't do cervical cancer screenings, you should find a gynecologist who will.
Although guidelines recommend that most individuals stop cervical cancer screenings by age 65, there are cases in which screening after that age is recommended — namely, for people at higher risk, including those with “a history of high-grade cervical lesions or cancer, people who have not been adequately screened, people whose mothers took a hormone called diethylstilbestrol (DES) while pregnant or people who have a weakened immune system,” says Diemert, who adds that people should talk with their health care providers about how often to get screened and until what age.
It’s also important to go to the doctor if you have any cervical cancer symptoms, notes Cooley. Early-stage symptoms include vaginal bleeding after sex, between periods or after menopause, as well as pelvic pain or pain during sex, according to NCI. Advanced-stage symptoms include difficult or painful bowel movements, rectal bleeding when having bowel movements, difficult or painful urination and dull backache.
Older individuals should know the general risks of cervical cancer and their own personal risk, says Diemert. These risks include a personal history of dysplasia (abnormal cell growth) of the cervix, vagina or vulva; a family history of cervical cancer; smoking; and other infections including chlamydia.
The good news is that if a precancer is found during screening, it can be treated, says Diemert, “keeping it from turning into a cervical cancer.”
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