Characterization of women diagnosed with cervical cancer at age 65 or older

Objectives: The objective of this study is to characterize the population of women who are diagnosed with cervical cancer after age 65. Current guidelines allow for discontinuation of cervical cancer screening at age 65 if women have met criteria for adequate screening, which is defined as three consecutive negative cytology results or two consecutive negative co-testing results within ten years before stopping screening, with the most recent test occurring within five years. However, twenty percent of incident cervical cancers occur in women over the age of 65. Download : Download high-res image (289KB) Download : Download full-size image Methods: A retrospective analysis of patients diagnosed with cervical cancer at age 65 or older from 2000-2020 at our institutions. Study subjects were identified by ICD-9 and ICD-10 codes. Demographic information, pathologic data, treatment history, and screening history were abstracted from the electronic medical record. Results: There were 53 patients diagnosed with cervical cancer at age 65 or older from 2000-2020 with sufficient records for review. The median age at diagnosis was 73.8 years, 59% were smokers, and 94% were White. The most common method of detection was the presence of symptoms (81%), and the most common presenting symptom was vaginal bleeding (70%), followed by vaginal discharge (23%), pelvic pain (17%), and bowel or urinary symptoms (13%). At diagnosis, 40% of patients had localized disease, 57% had regional disease, and 4% had distant disease at diagnosis. The histology distribution was 70% squamous cell carcinoma, 19% adenocarcinoma, 6% clear cell carcinoma, 4% small cell carcinoma, and 2% poorly differentiated carcinoma, unspecified. Only 19% of patients had a known history of prior abnormal screening, but prior screening history was not available for 32% of patients. A total of twelve patients (23%) had not met criteria for adequate cervical cancer screening; 3 patients (6%) had met criteria for adequate screening, and 4 patients (8%) were still undergoing screening due to abnormal results. For 34 patients (64%), however, there were insufficient screening records to determine whether they met criteria for adequate screening. Conclusions: Twenty percent of patients with complete records had met criteria to stop cervical cancer screening prior and went on to develop cervical cancer after age 65. This calls into question the current guidelines defining adequate screening prior to discontinuation. The remaining 80% of patients did not meet criteria for adequate screening and, thus, their cancers may have been detected and treated while still at a pre-invasive stage. Notably, there was not sufficient documented history of cervical cancer screening in 64% of these patients who were diagnosed with cervical cancer after age 65.