Once a woman hits age 65, the prospect of not having to put up with Pap smears anymore might be a big relief. Current guidelines for cervical cancer screening say that women age 65 and older who have had three normal Pap smears in the previous 10 years don’t need screening—or even a pelvic exam—anymore. “Whew! That’s one less annoyance to deal with” is what you might be saying. (No more lying down with your legs apart and feet braced in stirrups while a doctor pokes a swab into your privates.) But even though you don’t have to—and even though your gynecologist has been told by officials who draft guidelines not to bother—you may still want to get regular Pap smears past age 65, especially after reading about the latest research.
CORRECTING DEADLY ASSUMPTIONS
Although physicians commonly believed that the incidence of cervical cancer peaks in women who are between the ages of 40 and 44 and then declines, new research tells us that women age 65 and older actually have the highest rates of cervical cancer.
A little background: Researchers from the University of Maryland got to thinking that the long-accepted estimates of cervical cancer incidence might not be accurate, particularly when it came to older women, because these estimates did not exclude women who had had total hysterectomies. Women who have had this operation no longer have cervices (the lower portion of the uterus), so they can’t get cervical cancer. Including them in studies to determine cervical cancer rates is ridiculous. It skews estimates to be falsely low.
So the research team took a fresh look at the data and did it the right way. They excluded women who had had total hysterectomies and focused on cervical cancer incidence only in women with intact cervices. They expected to see higher cervical cancer rates overall—and they did.
In particular, they discovered that for every 100,000 women, 18.6 cases rather than the previously reported 11.7 cases of cervical cancer occur in the US population. But here’s where the corrected data become more alarming. Contrary to previous assumptions, incidence of cervical cancer increases steadily with age. It increases the fastest in women age 20 to 34, then slows down but does not decline. It continues to rise after age 35, peaking between age 65 and 69, just at the crucial time that doctors are telling women that it’s OK to forgo screening.
In fact, the new research discovered that, for every 100,000 women who are between age 65 and 69, 27.4 cases of cervical cancer occur—an incidence that’s a whopping 84% higher than what doctors had estimated before. When race as well as age was examined, it turned out that black women between the ages of 65 and 69 are particularly vulnerable. Incidence of cervical cancer was 53 cases per 100,000. This represents a 126% increase in cervical cancer incidence among older black women compared with previous estimates.
PROTECT YOURSELF!
This new study may be groundbreaking. The findings could—and should—force policymakers and medical experts who draft women’s health and cancer screening guidelines to reevaluate cervical cancer screening in older women. As expressed in other recent Daily Health News articles on ob/gyn issues, including an article on mammography screening, care-related decisions are being placed back in the hands of women. With that comes a pressing responsibility to be informed and proactive about your health. Ob/gyns currently recommend that women age 30 to 65 get Pap smears and HPV tests every three to five years unless there is a reason—such as testing positive for HPV—to get tested more often. Given the facts, you certainly can continue with Pap-smear and HPV testing as you cross over into your senior years despite what current guidelines say. But don’t wait for your doctor to suggest it. If continued screening is what you want to protect yourself, tell your ob/gyn, and don’t take no for an answer.
