According to a new study from UC Davis, nearly one in five new cervical cancer cases between 2009 and 2018 was in women age 65 and older. But what worries experts is that, according to the study, more older women (71%) had late-stage cancer than younger women (48%), which equates to lower survival rates that only get worse with age.
In general, if cervical cancer is diagnosed after it has spread to nearby tissues, organs or lymph nodes, the five-year relative survival rate is 59%, according to the National Cancer Institute (NCI). However, the study found that the five-year relative survival rate was lower for women over age 65 — only 23.2% to 36.8% — compared to women under age 65 (41.5%-51.5% ). (By comparison, when cervical cancer is diagnosed at an early stage, the five-year relative survival rate is 92%, according to the NCI.)
Current American Cancer Society (ACS) screening guidelines recommend that individuals over age 65 who have been screened for cervical cancer with normal results within the past 25 years and tested negative in the 10-year period before age 65 should not should be screened for cervical cancer. Once screening has stopped, please note the guidelines, it should not be restarted.
But as this study reveals, the risk of cervical cancer doesn’t just disappear at age 65.
Julianne Cooley, lead author of the study and senior statistician at UC Davis, tells Yahoo Life that the American Cancer Society predicts that 13,960 women in the U.S. will be diagnosed with cervical cancer by 2023, “and that 20% will be older than 65.” , she says.
Cooley says the study results are “extremely concerning” because “cervical cancer is preventable through screening and no one should die from this disease.”
Dr. Connie Liu Trimble, a professor of gynecology and obstetrics at Johns Hopkins Medicine, agrees, calling it a “travesty.” She tells Yahoo Life, “It shouldn’t be happening in this day and age.”
So what can older women do to protect their health? Here’s what experts say.
First, what causes cervical cancer?
Almost all cervical cancers are caused by HPV (human papillomavirus), a very common virus. According to the Centers for Disease Control and Prevention (CDC), approximately 13 million Americans become infected with HPV each year.
HPV is spread through vaginal, anal, and oral sex, as well as through skin-to-skin contact with an infected person’s genitals. “If you’ve had sex, you’ve been exposed to HPV — period,” Trimble says.
There are over 200 types of HPV, including low-risk types that can cause genital warts, and 14 high-risk types (specifically HPV16 and HPV18) that can cause various types of cancer – not just cervical cancer but also cancer of the vagina , vulva, penis, anus and back of the throat, according to the CDC.
In most cases, “the immune system can clear HPV, but the body’s ability to do that diminishes over time,” Dr. Renata Urban, a gynecologic oncologist at UW Medicine, told Yahoo Life.
But in some cases, HPV persists for several years — it can take 10 to 15 years for a precancer to become cancerous, if it does,” Trimble says — and causes abnormal changes in cervical cells that can lead to cancer.
Are current screening guidelines for older women falling short?
Although more than 20% of cervical cancer cases are found in women over the age of 65, these cancers are “rare” in those who have undergone regular cervical cancer screening before age 65, Sarah Diemert, nurse specialist and director of integration and evaluation of medical standards for Planned Parenthood Federation of America, Yahoo Life tells WebMD.
Urban says that because it can take a decade or more for HPV-infected cervical cells to become cancerous, coupled with the fact that there has been an increase in advanced stage cervical cancer in this older age group, it “means women are not getting appropriate screening. ” .” What’s not clear is why — are patients not going to their doctor’s appointments and missing years of cervical cancer screenings, or are doctors not doing the screenings? Or should screenings be renewed after age 65?
Cooley says her study results can’t determine whether screening should continue beyond age 65 “because we didn’t have data on whether the women over age 65 who were diagnosed with cervical cancer were screened before they turned 65.”
But, she says, “we do know that as many as 23% of women over the age of 18 are unaware of cervical cancer screening and many do not follow up on irregular screening results. Therefore, screening guidelines may be adequately but that older women did not follow screening guidelines before they turned 65, leaving them vulnerable to a diagnosis of late-stage cervical cancer.”
Older women may also underestimate their risk. Cervical cancer is most often diagnosed in women between the ages of 35 and 44, with an average age at diagnosis of 50 years, Diemert notes. “Many older women don’t realize that the risk of developing cervical cancer is still there as they get older,” she says.
How is late stage cervical cancer treated?
Treatment is usually a combination of chemotherapy and radiation, as well as a specialized treatment called brachytherapy, in which the radiation source is placed in the vagina, according to ACS.
However, Trimble says it can be “very difficult” to treat late-stage cervical cancer, especially in older patients. Urban points out that as patients get older, “they may develop more hypertension or diabetes, which can affect kidney function and affect their ability to tolerate the most common form of chemotherapy given with radiation. In addition, some of the side effects may include loose stools or diarrhea, but older women may be much more prone to dehydration and fatigue,” so these side effects may hit them harder.
What can older women do to protect their health?
“These study results reinforce the need for anyone with a cervix to get regular cervical cancer screening and other forms of cancer screening,” says Diemert.
For Cooley, she says it’s important to determine whether women have met screening guidelines before they turn 65 before regular screening is discontinued. “If older women don’t get regular screening before they turn 65, they should schedule a catch-up test as soon as possible,” she says. Trimble adds that if your GP doesn’t or won’t do cervical cancer screening, you should find a gynecologist who does.
While guidelines recommend that most people stop cervical cancer screening at age 65, there are instances where screening is recommended after that age — namely, for those at higher risk, including those with “a history of high-grade cervical lesions or cancer, people who haven’t been screened enough, people whose mothers took the hormone diethylstilbestrol (DES) during pregnancy, or people with weakened immune systems,” says Diemert, adding that people should talk to their healthcare providers about how often they should be screened and until what age.
It’s also important to see a doctor if you have symptoms of cervical cancer, Cooley notes. Early-stage symptoms include vaginal bleeding after sex, between periods, or after menopause, as well as pelvic pain or pain during sex, according to NCI. Advanced stage symptoms include difficult or painful bowel movements, rectal bleeding with bowel movements, difficult or painful urination, and dull back pain.
Older individuals should know the general risks of cervical cancer and their own personal risk, says Diemert. These risks include a personal history of dysplasia (abnormal cell growth) of the cervix, vagina, or vulva; a family history of cervical cancer; to smoke; and other infections, including chlamydia.
The good news is that if a precancer is found during screening, it can be treated, says Diemert, “to prevent it from becoming cervical cancer.”
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