Abstract
The incidence and mortality of cervical cancer are high in Danish women aged 60 years and older who are about to exit the cervical cancer screening program. The present study aimed to describe the screening history in women ≥60 years old, diagnosed with cervical cancer in Denmark, 2009‐2013. We retrieved information on cases of cervical cancer and previous cervical cancer screening from national registries. During the study period, a total of 1907 women were diagnosed with cervical cancer, 574 (30.1%) of which were ≥60 years old. The majority of women were diagnosed with squamous cell carcinoma (73.7%) and advanced‐stage disease (ASD, ie, ≥FIGO IIB; 63.1%). The proportion of ASD increased with age, from 51.9% in women aged 60‐64% to 76.7% in women aged 75‐79. Among screened women (n = 377), 22.8% had a cervical cytology within 5 years of diagnosis, 73.3% of which were normal, and 45.1% were diagnosed with ASD. Women who had been sufficiently screened prior to screening exit (≥2 normal cytology test in the age interval 50‐59) accounted for 18.1%. Of note, 53.8% of the sufficiently screened women were diagnosed with ASD. Sufficiently screened women were less likely to be diagnosed with ASD compared to never‐screened women (53.8% vs 67.5%, P < 0.020), but no difference was observed between sufficiently and insufficiently screened women (53.8% vs 63.4%, P = 0.091). Our findings suggest that cancer in older women may occur due to insufficient screening prior to screening exit, a low sensitivity of screening, and premature screening exit.
Highlights
Since the implementation of cervical cancer screening, cervical cancer incidence and mortality have declined significantly in developed countries, including Denmark.[1]
Among screened women (n = 377), 22.8% had a cervical cytology within 5 years of diagnosis, 73.3% of which were normal, and 45.1% were diagnosed with advanced‐stage disease (ASD)
In 2016, nearly one‐third of cervical cancer cases in Denmark were found in women aged 60 and older, and their mortality rate was four times higher than for women
Summary
Since the implementation of cervical cancer screening, cervical cancer incidence and mortality have declined significantly in developed countries, including Denmark.[1]. There has been an ongoing debate on when to stop cervical cancer screening, as opinions on the value of screening older women have been divided. The International Agency for Research on Cancer (IARC) recommends to stop screening at age 60 or 65 if a woman has had at least two normal cervical cytology tests prior to the screening exit.[6] American guidelines recommend cessation of screening at age 65 years in sufficiently screened women, defined as having had three consecutive normal cervical cytology tests or two consecutive normal cotests within 10 years of screening exit and no diagnosis of cervical intraepithelial neoplasia grade 2 or worse within the past 20 years.[7] The decision on when to stop screening in developed countries is largely based on expert opinion and modeling studies, as research with a more rigorous methodology is limited
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