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Women with normal Pap smears in their 50s unlikely to develop cervical cancer as they age
Clinical Question
Can cervical cancer screening be discontinued in some women older than 60 years?
Bottom line
Women who have regular cervical cancer screening in their 50s and have normal results do not benefit from additional screening in their 60s and can consider stopping screening. On the other hand, women who have not had screening before age 60, or have had abnormalities discovered in their 50s and are at increased risk for cervical cancer, can benefit from additional screening from ages 60 to 65 years. 1b
Reference
Study design: Cohort (prospective)
Funding: Foundation
Setting: Population-based
Synopsis
These researchers identified 569,132 women who'd lived in Sweden since they were 51 years of age. Using a population register they calculated the women's cumulative incidence of cervical cancer from ages 61 to 80, separating women into 3 groups at age 60: unscreened, screened with abnormalities in their 50s, and screened with normal results in their 50s. The cumulative incidence of cervical cancer for women aged 61 to 80 years was 1.6/1000 for those with adequate screening in their 50s and normal results, and 2.5/1000 for those with inadequate screening yet normal results. Further screening of women in this group was not associated with a significant decrease in cervical cancer between the ages of 61 and 80 years. In women who did not have screening in their 50s, the incidence up to age 80 was 5.0/1000 and continued screening decreased cervical cancer by 3.3/1000. Women screened with abnormal results in their 50s had an average cumulative incidences of cervical cancer up to age 80 of 9.7/1000 with low-grade lesions and 15.3/1000 with high-grade lesions (if screening was not continued). For women with low-grade and high-grade lesions found in their 50s, continued screening decreased the likelihood of cervical cancer by 5.8 and 7.5 cases, respectively, per 1000 women.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Needs to be in the public domain ..... Many women drop screening in their 50s and 60s.
We need an integrated national emr so we can make these powerful health decisions.here in Nova Scotia we do not have this capability
Il est bon de voir que si une femme a eu un bon dépistage dans la cinquantaine sans anomalie au pap, que l’on peut envisager de ne plus faire de pap après 60 ans.
I would be concerned about stopping screening in this age group with increasing incidence of divorce etc. I wonder if the authors have a subgroup analysis based on relationship status. Have certainly seen women with lifelong normal paps all of a sudden have HSIL after the breakdown of their 20+ year marriage.
Good poem
Current BCCA guidelines and Colleges of OBGYN still recommend screening to age 69. Until that changes - I will keep screening q3yr to age 69.
I will not change my practice until the official guidelines change
Would want to run this information past the people at CervixCheck before changing my practice as their current recommendation is to continue until age 69.