Cervical Cancer Screening: Is the Age Group 30-65 Years Optimum for Screening in Low-Resource Settings?

Abstract

An Operational Framework document for population-wide screening of common cancers in India was launched in 2016. The target age for screening is 30-65years for cervical, breast and oral cancers. This study was designed to review the frequency and distribution of cervical lesions among women aged 21-29, 30-65 and > 65years. A retrospective review of all satisfactory cervical smears (n = 79,896) received over a ten-year period (2010-2019) was conducted. Three age bands were defined: 21-29years, 30-65years and > 65years. The frequency and distribution of the various epithelial cell abnormalities (ECAs) across the three age bands were calculated. Cytohistologic correlation was performed wherever available. Of the 1357 ECAs (1.7% of all smears), about 16.9% were seen in the age band 21-29years, while 4.5% presented in > 65years of age. About 80% of the ECAs seen in younger women were low-grade squamous lesions, while 75% of lesions in women > 65years were high-grade squamous abnormalities. Among the total 512significant high-gradeand malignant(squamous and glandular) lesions, 5.6% presented in women 21-29years, while 10.1% were seen in > 65years of age. Majority of the significant cervical lesions would be detected if the screening focuses on the 30-65years age group. However, about 19% of high-grade squamous preneoplasticlesions(ASC-H/ HSIL) and 13% of preneoplasticglandular lesions(AGC-N) are likely to be missed if women 21-29years and > 65years are excluded. The cost of screening incurred by including these age groups has to be weighed against the benefits derived, especially in low-resource settings. In the absence of universal implementation of HPV immunization, there is a felt need to enhance cervical cancer awareness and encourage screening, more so in high-risk category and symptomatic females beyond the selected age group.