Terminal Cervical Cancer on the Rise in Older Women
Deadly cervical cancer appears to be on the rise among American baby boomer women, according to one study, highlighting a possible need for new screening criteria.
While cervical cancer cases have declined across the United States thanks to modern advances in early detection and prevention, terminal cervical cancer cases among older women seem to be moving in the wrong direction.
Older women were diagnosed with late-stage cervical cancer more often than their younger peers over the past decade, according to an analysis of California Cancer Registry data.
The new study highlights a population of women possibly overlooked by America's healthcare system, as women are most likely to be diagnosed with cervical cancer between the ages of 35 and 44, according to the American Cancer Society.
The research was conducted by experts at the University of California Davis Comprehensive Cancer Center who used a decade of data on patients 21 and older diagnosed with cervical cancer between 2009 and 2018. They found an increase in the number of Californian women, ages 65 and older, diagnosed with terminal cervical cancer and dying of the disease.
"Our findings highlight the need to better understand how current screening guidelines might be failing women 65 and over," said Julianne Cooley, UC Davis senior statistician, in a news release.
The UC Davis research, published Jan. 9 in Cancer Epidemiology, Biomarkers & Prevention, found 1 in 5 new cervical cancers diagnosed from 2009 to 2018 were in women older than 65. More of these women (71 percent) presented with late-stage disease than younger women (48 percent), with the number of late-stage diagnoses increasing up to age 79, according to the release.
Late-stage, five-year relative survival was lower for women 65 and older (23.2 percent to 36.8 percent) compared with patients younger than 65 (41.5 percent to 51.5 percent). Women 80 years and older had the lowest survival of all age groups, the release stated.
The researchers noted that the findings raise questions about America's current medical guidance, which suggests women 65 and older may refrain from regular cervical cancer screenings and Pap smears in later years in consultation with their doctor.
Cervical cancer, although highly treatable if detected early, is typically asymptomatic in its earlier stages, producing few noticeable signs or symptoms.
When red flags such as pelvic pain and abnormal bleeding arise, it's often a sign of late-stage cervical cancer. Other cervical cancer symptoms may include lumps in the groin area, drastic changes in appetite or weight, and pain during sexual intercourse.
Prevention is crucial
The difference between an early or late cervical cancer diagnosis is often a matter of life or death.
Late-stage cervical cancer cases have a 17 percent five-year relative survival rate, whereas the overall survival rate for cervical cancer is 67 percent, according to the National Cancer Institute. The survival rate is 92 percent when cervical cancer is detected in the early stage.
The World Health Organization and the U.S. Preventive Services Task Force currently recommend women ages 21 to 65 receive regular cervical cancer screenings to check for precancerous abnormalities.
Women who receive regular cervical cancer screenings are less likely to get cervical cancer and much less likely to die from it, according to the Centers for Disease Control and Prevention.
"To help prevent cervical cancer or catch it early, the U.S. Preventive Services Task Force recommends screening for cervical cancer every three years with a Pap test alone in women aged 21 to 29," the CDC's current guidance states. "Women aged 30 to 65 should be screened every three years with a Pap test alone, every five years with high-risk human papillomavirus [HPV] testing alone, or every five years with both tests [co-testing]."
'Women aged 30 to 65 should be screened every three years with a Pap test alone, every five years with high-risk human papillomavirus [HPV] testing alone, or every five years with both tests [co-testing].'
The UC Davis research comes on the heels of a 2022 study conducted by the University of California Los Angeles Department of Obstetrics and Gynecology that analyzed stage IV cervical cancer cases diagnosed between 2001 and 2018.
The UCLA team found an overall 1.3 percent annual increase in late-stage cervical cancer, with the greatest annual increase of 4.5 percent documented among Southern white women between the ages of 40 and 44. The study also suggested a rise in the number of late-stage cervical cancer cases among 30-year-old women.
Prevention by means of HPV vaccination remains one of the most effective defenses against this type of cancer as HPV causes more than 90 percent of cervical cancer cases.
HPV, the most common sexually transmitted disease in the U.S., has more than 100 different strains, most of which are asymptomatic. HPV is so pervasive in the U.S. that the CDC estimates almost all sexually active Americans will be infected by some form of HPV over the course of their lifetime. More than 42 million Americans currently have HPV, with 13 million new infections added each year.
In addition to cervical cancer, HPV also causes cancers of the vulva, vagina, penis, anus and back of the throat in men and women. More than 4,000 women die annually from cervical cancer, regarded as one of the most preventable HPV-related cancers.
To protect against the virus, the CDC recommends two HPV vaccine doses for children ages 11 to 14, or three doses for people 15 to 45 years of age and those who are immunocompromised.
Future cervical cancer incidence rates may be worse, as the data analyzed in both University of California studies did not include cancer cases reported during the global COVID-19 pandemic.
HPV vaccination rates saw a drastic 84 percent decline in 2020 near the height of the pandemic, according to the CDC, as many immunocompromised individuals opted to postpone regular doctor visits.
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