Abstract
Guidelines for screening of cervical cancer and pelvic exams for older women have recently changed. These changes may have unexpected sequelae in women over 65 years of age. This manuscript provides a review of gynecologic screening recommendations for older women in the U.S. and potential ramifications of these recent changes. Peer reviewed guidelines from the American College of Obstetrics and Gynecology, U.S. Preventative Task Force Services, the American Cancer Society, The Centers for Disease Control, and multiple original research articles and reviews were reviewed for this manuscript. Women over 65 are at greatest risk to develop late stage diagnoses of cancers, pelvic organ disease, incontinence, and infections. Clinicians will need to acutely consider this fact when communicating and screening this population. We conclude that practitioners should be aware of the new guidelines and should consider including gynecologic health history and symptom analysis as part of annual exams in women of all ages.
Highlights
Over the past several years there have been policy changes and updates to practice guidelines in the United States (U.S.) for women’s, older women’s health screenings, namely cervical cancer screening, otherwise known as the Papanicolaou smear (Pap smear) [1]
30 to 65 include either co-testing with Human Papillomavirus (HPV) test and Pap smear, or HPV only testing as a primary screening option with screening intervals ranging from three to five years [1]
Decreased gynecologic screening has the potential to become problematic for older women, as we know women over 65 remain at the highest risk for benign, infectious, and malignant disorders that decrease functionality and/or longevity, if left untreated
Summary
Over the past several years there have been policy changes and updates to practice guidelines in the United States (U.S.) for women’s, older women’s health screenings, namely cervical cancer screening, otherwise known as the Papanicolaou smear (Pap smear) [1]. In older women, recent changes in guidelines may adversely affect the identification and treatment of gynecological disorders This manuscript provides a review of gynecologic screening recommendations in women over 65 and describes older women’s common gynecologic problems, and discusses possible ramifications if routine screening is eliminated from this population group. The new gynecologic guidelines may lead primary health care providers to see fewer women over age 65 routinely; and as a result, fewer women will have yearly screening mechanisms, as many women use their OB/GYN provider as a primary care provider [17]. Another possible outcome would be eliminating interaction with specialized professionals in gynecology and, as a result, poorer, less complete sexual and gynecological screening. Many older women mistakenly deduce symptomatic complaints to normal processes of aging and often, due to generational and cultural norms, may not openly ask a PCP about urinary or sexual complaints [22,23,24]
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