BACKGROUND AND PURPOSE:

• Guidelines from a number of professional groups suggest discontinuation of cervical cancer screening for women who are >65 years old, if they meet the following criteria
  • Average risk | Adequate negative screening prior to discontinuation
• However, recent data suggests that women >65 constitute approximately 20% of new cervical cancer cases
• Mills et al. (Gynecologic Oncology, 2021) explored the real-world applicability of screening exit criteria

METHODS:

• Cross-sectional study
• Populations
  • Cohort 1: Women aged 64 | Employer-sponsored insurance enrolled in a national database between 2016 and 2018
  • Cohort 2: Women aged 64 to 66 years receiving primary care at a safety net health center in 2019
• Study design
  • Patients were evaluated for exit eligibility by current guidelines
    • Exit due to hysterectomy
    • Exit due to screening
  • Criteria for screening exit include
    • 2 consecutive negative HPV tests or HPV plus Pap co-tests, or 3 consecutive negative Pap tests within the prior 10 years
    • No diagnosis of a precancerous lesion in the past 25 years

RESULTS:

• 590,901 women in the national claims database (cohort 1)
  • Eligible for exit: 22.25%
    • Due to hysterectomy: 1.6%
    • Due to negative screening: 20.6%
• 1544 women in the safety net health center (cohort 2)
  • Eligible for exit: 34.2%
    • Due to hysterectomy: 9.3%
    • Due to negative screening: 24.9%
• Most women did not have sufficient data available to fulfill exit criteria
  • National database: 64.7%
  • Safety net hospital system: 56.7%
• Even among women with 10 years of insurance claims data, only 41.5% qualified to discontinue screening

CONCLUSION:

• Approximately two-thirds of women ≥64 years did not qualify for cervical cancer screening exit
• Cervical cancers in women >65 may be prevented with adequate screening performed between 55 and 65 years

Learn More – Primary Sources:

Eligibility for cervical cancer screening exit: Comparison of a national and safety net cohort