Majority of women do not meet exit criteria for cervical cancer screening

Current guidelines recommend stopping cervical cancer screening at age 65, but women over 65 account for more than one in five new cervical cancer diagnoses and are twice as likely to die after one diagnosis cervical cancer than younger women. New research from Boston Medical Center has found that less than one in three women aged 64 to 66 met the criteria for discontinuing cervical cancer screening while examining patients receiving both. private insurance and a hospital with a safety net. Posted in Gynecological oncology, the researchers found that even among women with 10-year continuous insurance coverage, 41.5% were not eligible to end screening and most women had not received a adequate screening in the ten years preceding this important screening decision.

The majority of women aged 65 and over may be at risk for cervical cancer due to inadequate screening or high-risk pre-existing conditions. Study results show that up to 20 percent of women reported a medical condition or a history of screening abnormalities that made screening necessary beyond age 65. This highlights the need to educate patients and health care providers on the importance of ensuring adequate screening for cervical cancer. between 55 and 65 years of age, as well as for high-risk conditions that require screening beyond 65 years. When the data are adjusted for patient hysterectomies, the incidence of cervical cancer is highest in women aged 65 to 69 and remains high until the age of 85.

Providers should be aware that cervical cancer is a growing problem in women 65 years of age and older and is preventable. It is imperative that providers proactively ensure their patients receive adequate screening between ages 55 and 65 to reduce preventable cancers in women over 65, and to ensure their patients are screened. adequate to be able to safely exit screening, if their medical history is admissible. “

Rebecca Perkins, MD, MPH, MD, Obstetrics and Gynecology at BMC

Study data included 590,901 women aged 64 with employer-sponsored insurance enrolled in the national Truven MarketScan database between 2016 and 2018, and 1,544 women aged 64 to 66 receiving primary care in a safety net health center in 2019, identified through an electronic health record. to question. Eligibility to exit screening was determined using current guidelines which include: no evidence of cervical cancer or seropositivity, no evidence of pre-cervical cancer during of the past 25 years and evidence of a hysterectomy with removal of the cervix or fulfilling the discharge selection criteria. Discharge criteria are defined as two human papillomavirus (HPV) tests or HPV plus Pap co-tests or three Pap tests in the past 10 years without evidence of an abnormal result (screening with HPV test or HPV / Pap co-test provides more long-term assurance against the development of cancer than the Pap test alone).

Data from both the hospital and national safety net claims database indicated that less than half of women aged 64 to 66 had sufficient screening documentation to meet screening criteria. exit. The guidelines specify that patients with immunosuppression, a history of abnormal results, or cervical precancer or cancer should continue screening. Current exit criteria for screening are complex and require a detailed review of at least ten years of medical record documentation, which can create barriers to applying the guidelines to clinical practice.

“No patient should stop screening based on age alone without their health care provider performing a thorough review of their medical history,” says Perkins, also an associate professor of obstetrics and gynecology at the faculty. of Medicine from Boston University. “Better screening for cervical cancer in women 55 and older can reduce cancer rates and mortality in women 65 and older.”

Possible solutions to improve these rates include a Medicare-funded cancer prevention visit where the need for cervical cancer screening is discussed, and optimization of electronic medical records to prompt review of criteria for cervical cancer screening. screening for cervical cancer before stopping a patient’s screening.


Journal reference:

Mills, JM, et al. (2021) Eligibility for discharge from cervical cancer screening: comparison of a national cohort and a safety net. Gynecological oncology.

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