A new study from the University of Illinois confirms a link between routine Pap smear screenings and a lower risk of developing cervical cancer in women over age 65. However, most American health guidelines discourage women in that age range from receiving screenings unless they have pre-existing risk factors.
The new findings are published in the journal Gynecologic Oncology.
"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, a cancer epidemiologist and a professor of kinesiology and community health at Illinois. "There's been a great debate about it."
Early research on cervical cancer screenings recommended not testing women over age 50. This suggested age cutoff for screening was increased in recent years as the disease and risk factors are better understood.
"While the incidence of cervical cancer is greater in adult women under the age of 65 years, those over 65 tend to have more fatal cases of the disease," Rosenblatt said.
When detected early - often via a Pap test - pre-malignant cervical cancer tissue can be removed or treated so it does not progress into malignant cancer.
"If you have regular Pap smears, there is a greater chance the doctor will catch it before it progresses to malignant cervical cancer," Rosenblatt said.
She assessed whether regular Pap tests reduce the risk of cervical cancer, specifically in women over age 65.
Rosenblatt and her team looked at Medicare billing data from 1991-99 and extracted information for more than 1,200 women who had been recently diagnosed with cervical cancer, as well as a group of more than 10,000 patients who had no cancer diagnosis. The researchers determined which of the patients had received a screening Pap smear two to seven 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.
These results imply that routine Pap tests are beneficial for preventing malignant cervical cancer in women over 65, she said.
Rosenblatt said there needs to be a more thorough cost-benefit analysis of conducting the screenings in elderly women. While 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.
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Karin A. Rosenblatt et al, Case-control study of cervical cancer and gynecologic screening: A SEER-Medicare analysis, Gynecologic Oncology (2016). DOI: 10.1016/j.ygyno.2016.06.016