Current guidelines may underestimate U.S. cervical cancer incidence and older women's risk

Rates of cervical cancer in American women may be higher than previously thought, and the disease may arise most often at an age when adequately screened women are advised to stop getting screened. The findings come from a new study published online in Cancer.

“In order to make accurate estimates of the true rates of cervical cancer by age in the United States and monitor trends in the occurrence of disease, it is important to calculate the occurrence of cervical cancer only among women who are at risk,” says Anne Rositch, PhD, of the University of Maryland School of Medicine. To do so, Dr. Rositch and her colleagues analyzed hysterectomy prevalence and cervical cancer incidence from 2000 to 2009.

When the researchers estimated cervical cancer rates only among women who had not undergone a hysterectomy, they found that rates of disease in older women were much higher than previously reported. Overall, incidence rates were 11.7 cases per 100,000 women before correcting for hysterectomies, compared with 18.6 per 100,000 after correction. Also, previous reports showed that the incidence peaks at age 40 to 44 years (15.6 cases per 100,000 women) and then levels off. After correcting for hysterectomy, though, the incidence continued to increase with age, peaking at a higher rate (27.4 cases per 100,000 women) and at a higher age (65 to 69 years). The effect was most pronounced among African American women.

The authors say that their findings should be considered when setting national guidelines for the appropriate age to stop screening for cervical cancer. “Current guidelines recommend exiting women with recent negative screening from routine screening at age 65 years, yet our corrected calculations show that women just past this age have the highest rate of cervical cancer,” says senior author Patti Gravitt, PhD.  Read the study abstract.