Routine cervical screening should be provided for women aged 65 and older, as they remain at significant risk of developing cervical cancer due to human papillomavirus (HPV), according to recent studies.
Even though cervical cancer is largely preventable, approximately 660,000 cases and 350,000 deaths were recorded globally in 2022, as reported by the World Health Organization (WHO).
HPV causes about 95% of cervical cancers. This occurs when abnormal cells form in the cervix, which can subsequently develop into tumors.
The WHO’s global strategy on cervical cancer aims for every country to vaccinate 90% of girls with the HPV vaccine by the age of 15, screen 70% of women, and treat 90% of those identified with cervical diseases by 2030. According to modeling, achieving these targets could prevent around 62 million deaths and 74 million new cases by 2120.
Screening practices differ by country, but most guidelines suggest discontinuing cervical screenings after age 65 if previous results have been normal.
However, cases of cervical cancer in women over 65 have been increasing. In 2022, there were 157,182 new cases and 124,269 deaths from the disease in this demographic globally.
In the UK, although screening and vaccination rates are relatively high compared to other nations, these rates have been declining recently. Cervical cancer results in about 685 deaths each year in England alone.
A comprehensive observational study published in Gynecology and Obstetrics Clinical Medicine indicates that older women are more likely to test positive for HPV and show abnormal cell results compared to their younger counterparts.
Researchers analyzed cervical cancer screening data from over 2 million women collected between 2017 and 2023, finding that 17,420 were aged 65 or older.
The findings revealed a higher occurrence of high-risk HPV infections and abnormal results in older women. Nearly 14% of women over 65 tested positive for high-risk HPV types, in contrast to 8% of younger women.
Older women were also more likely to be infected with multiple HPV types and have abnormalities detected during screenings.
While there are limitations to the study, the results indicate that “women aged 65 and above represent a high-risk group for cervical cancer incidence and mortality, warranting urgent attention worldwide,” according to the study authors.
They added that “most guidelines suggest stopping screening for those under 65 with adequate primary screening and no high-risk factors. However, the situation is different for those over 65, who may not have been vaccinated or thoroughly screened. Given the increasing life expectancy, the risk of cervical cancer in this group is significantly higher.”
Athena Lamnisos, the chief executive of the Eve Appeal cancer charity, noted that there is a largely unvaccinated population over 65 who might still be at high risk for cervical cancer if they haven’t been screened adequately.
She urged the National Screening Committee to consider reviewing the screening age in light of these findings.
Maxine Lenza, health information manager at Cancer Research UK, commented that the recent improvements in testing in the UK have made it an effective means of preventing cervical cancer. Women over 65 who have kept up with their screenings have a very low risk of developing the disease. However, those who haven’t been screened can request a test through their GP.
An NHS spokesperson highlighted that the cervical screening program in England follows expert guidance on age and screening frequency, based on ongoing reviews of the latest evidence.
Women who get an HPV-positive result at age 65 are invited for further monitoring. The spokesperson emphasized the importance of attending screenings to ensure protection against cervical cancer.
A representative from the Department of Health and Social Care mentioned that the current age guidelines are based on solid scientific findings and expert recommendations. Still, women concerned about symptoms are encouraged to consult their GP for the best course of action.
Ultimately, increasing participation in screenings among women within the established age limits is crucial. As part of a ten-year health plan, eligible women will be given access to convenient HPV self-sampling kits to help address healthcare barriers as the focus shifts from treatment to prevention.
