Assessment of cervical cancer screening policy in Korea for women over age 65

Abstract

The purpose of this study was to evaluate the efficacy of cervical cancer screening (CCS) in Korean women over 65 years of age and to determine the age at which CCS becomes inefficacious, so that providers and policy makers can be more informed about when to stop screening. The data of 999 women, who underwent CCS followed by colposcopy at the Korea University hospital from January 2007 to May 2012, were retrospectively evaluated. Age groups were classified as <21 (n=11), 21-29 (n=128), 30-65 (n=768), and >65 (n=92). To evaluate the value of CCS in women older than 65, age groups were simply divided into ≤ 65 or >65. Participants were also categorized into five strata of age groups (≤ 55 vs. >55, ≤ 60 vs. >60, ≤ 65 vs. >65, ≤ 70 vs. >70, and ≤ 75 vs. >75) that were compared to the sample to assess a cutoff-age at which to cease screening based on decreased efficacy. The mean age was 45.5 ± 13.7 (range 14-80). There were no differences in the pathologic results for cervical intraepithelial neoplasia (CIN) values of < CIN2 vs. ≥ CIN2, or ≤ CIN3 vs. cancer among the groups. There was a significantly higher incidence of cancer compared with ≤ CIN3 in women aged >65 (13.0%) vs. ≤ 65 (6.6%), (p=0.037). To assess the cervical cancer incidence (CCI) from the larger number of cases by age, a prediction formula was calculated from a national dataset. CCI (per 100,000) continuously increased by age even for those in their 90 s. CCS is still necessary in Korean women older than 65 since there is a substantial CCI rate occurring in these women. It is time to consider new guidelines that include the appropriate age and conditions for discontinuing screening.