Most patients with cervical cancer who are past the age of routine screening are diagnosed with locally advanced or metastatic disease, according to a study published in Gynecologic Oncology.
The researchers noted that an estimated 14,480 patients were diagnosed with cervical cancer in the United States in 2021. An estimated 20% of these patients were older than 65 years, and most had exited routine cervical cancer screening.
With the current study, researchers wanted to learn more about this patient population. The team analyzed SEER-Medicare data from 2004 through 2013, which encompassed 2274 patients age 65 years or older who were diagnosed with cervical cancer.
The median age was 76.1 years, and 27.9% of cases occurred in patients older than 80 years of age. About 63% of patients were diagnosed with stage II or higher disease, and 23.1% were diagnosed with stage IV disease.
Nearly 15% of patients were not treated. A lack of treatment was associated with age older than 80 years, 3 or more comorbidities, and stage IV or unknown stage disease.
“It remains unclear if these women declined or were not offered treatment; however, this is consistent with previous studies showing that, stage for stage, women ≥65 are treated less aggressively compared to women <65,” the researchers wrote.
Of the patients who were treated, the most common treatment was surgery with adjuvant chemotherapy and/or radiotherapy (41.9%), followed by radiotherapy alone (18.8%).
The median survival after diagnosis was 56 months, and the 5-year cancer-specific survival rate was 49.5%.
In multivariate analyses, all treatment types except chemotherapy alone were significantly associated with improved cancer-specific survival. Increasing age and disease stage at diagnosis were associated with decreased cancer-specific survival.
“Given that screening is associated with a significantly reduced risk of cervical cancer, advanced stage disease, and death from the disease, the discontinuation of screening at age 65 for the majority of women may play a role in the late stage at diagnosis and subsequently more difficult treatment decisions and outcomes in this population,” the researchers wrote.
“Coupled with the fact that the life expectancy is increasing, and the number of women with an intact cervix is increasing as a result of declining hysterectomy incidence rates, these findings may also suggest a need to continue screening beyond the age of 65,” the team concluded.
Lichter KE, Levinson K, Hammer A, Lippitt MH, Rositch AF. Understanding cervical cancer after the age of routine screening: Characteristics of cases, treatment, and survival in the United States. Gynecol Oncol. Published online January 31, 2022. doi:10.1016/j.ygyno.2022.01.017