Cervical cancer in the elderly: Was their screening adequate? (450)

Abstract

Objectives: To determine the proportion of women diagnosed with cervical cancer at 65 years of age or older who met criteria for discontinuation of screening prior to cancer diagnosis and evaluate for predictors of adequate screening. Methods: A retrospective review was performed of all women in Kaiser Permanente Northern California diagnosed with cervical cancer at the age of 65 or older between 2006 and 2017. Current cervical cancer screening guidelines allow discontinuation of cervical cancer screening at age 65 if the patient had three normal consecutive cytology tests or two normal consecutive co-tests (cervical cytology + HPV) ten years prior to stopping screening. Adequate screening was defined as meeting stopping criteria in any ten-year interval starting at age 55 or older but prior to cancer diagnosis. Cervical cancer screening results were extracted from the medical record dating from the earliest records of 1993 until the cancer diagnosis. Bivariate predictors of adequate screening history were evaluated using Chi-square or Fisher’s exact tests. Results: From 2006 to 2017, 220 Kaiser Permanente Northern California members aged > 65 years were diagnosed with cervical cancer. The median age at the time of diagnosis was 74 years (range: 65-98). One hundred and forty-three patients had squamous cell carcinoma (65%), 45 (20%) had adenocarcinoma and 32 (15%) had other types. Fifty-seven percent of patients were non-Hispanic White, 15% were Hispanic, 13% were Asian, and 8% were non-Hispanic Black. Forty percent of patients were current or former smokers. Sixty- nine patients (31.3%) met the criteria for adequate screening over a 10-year interval starting at age 55 or older prior to cancer diagnosis. Among patients who met adequate screening criteria, the median time interval from last normal cervical cancer screening to cancer diagnosis was 5.3 years. Patients with squamous cell histology were less likely to have met the criteria for cessation of screening (23%) as compared to those with adenocarcinoma (44%) or other histology (50%) (p <0.001). None of the following factors were predictive of adequate screening history: age, race/ethnicity, body mass index (BMI), smoking history (ever vs never smoker). Conclusions: Nearly one-third of women aged > 65 years diagnosed with cervical cancer despite meeting the criteria for exiting cervical cancer screening. Opportunities exist to improve both screenings for women who were inadequately screened, as well as to re-evaluate criteria for discontinuation of cervical cancer screening in women over 65 years of age. Objectives: To determine the proportion of women diagnosed with cervical cancer at 65 years of age or older who met criteria for discontinuation of screening prior to cancer diagnosis and evaluate for predictors of adequate screening. Methods: A retrospective review was performed of all women in Kaiser Permanente Northern California diagnosed with cervical cancer at the age of 65 or older between 2006 and 2017. Current cervical cancer screening guidelines allow discontinuation of cervical cancer screening at age 65 if the patient had three normal consecutive cytology tests or two normal consecutive co-tests (cervical cytology + HPV) ten years prior to stopping screening. Adequate screening was defined as meeting stopping criteria in any ten-year interval starting at age 55 or older but prior to cancer diagnosis. Cervical cancer screening results were extracted from the medical record dating from the earliest records of 1993 until the cancer diagnosis. Bivariate predictors of adequate screening history were evaluated using Chi-square or Fisher’s exact tests. Results: From 2006 to 2017, 220 Kaiser Permanente Northern California members aged > 65 years were diagnosed with cervical cancer. The median age at the time of diagnosis was 74 years (range: 65-98). One hundred and forty-three patients had squamous cell carcinoma (65%), 45 (20%) had adenocarcinoma and 32 (15%) had other types. Fifty-seven percent of patients were non-Hispanic White, 15% were Hispanic, 13% were Asian, and 8% were non-Hispanic Black. Forty percent of patients were current or former smokers. Sixty- nine patients (31.3%) met the criteria for adequate screening over a 10-year interval starting at age 55 or older prior to cancer diagnosis. Among patients who met adequate screening criteria, the median time interval from last normal cervical cancer screening to cancer diagnosis was 5.3 years. Patients with squamous cell histology were less likely to have met the criteria for cessation of screening (23%) as compared to those with adenocarcinoma (44%) or other histology (50%) (p <0.001). None of the following factors were predictive of adequate screening history: age, race/ethnicity, body mass index (BMI), smoking history (ever vs never smoker). Conclusions: Nearly one-third of women aged > 65 years diagnosed with cervical cancer despite meeting the criteria for exiting cervical cancer screening. Opportunities exist to improve both screenings for women who were inadequately screened, as well as to re-evaluate criteria for discontinuation of cervical cancer screening in women over 65 years of age.