Cervical Cancer Stage at Diagnosis and Survival among Women ≥65 Years in California

Abstract

Background: Through adequate screening and follow-up, cervical cancer can be prevented or detected at early-stage (stage I), which is related to excellent survival. Current guidelines recommend discontinuing screening for women ≥65 years with history of normal Pap and/or HPV tests, potentially leaving this age group vulnerable. This study examined late-stage disease in a population-based cohort. Methods: Using California Cancer Registry data, we identified 12,442 patients ages ≥21 years with a first primary cervical cancer diagnosed during 2009–2018. Proportions of late-stage disease (stages II–IV) and early- and late-stage 5-year relative survival are presented by the age group. Among patients ages ≥65 years, multivariable logistic regression estimated associations of sociodemographic and clinical characteristics with late-stage cervical cancer. Results: Nearly one fifth of patients (n = 2,171, 17.4%) were ≥65 years. More women ages ≥65 years (71%) presented with late-stage disease than younger women (48% in patients ages <65). Late-stage 5-year relative survival was lower for women ≥65 years (23.2%–36.8%) compared with patients <65 (41.5%–51.5%). Characteristics associated with late-stage cervical cancer in women ≥65 years included older age [odds ratio (OR), 1.02; 95% confidence interval (CI), 1.01–1.04; each year], non-adenocarcinoma histologic subtypes, and comorbidities (OR, 1.59; 95% CI, 1.21–2.08). Conclusions: There remains a significant burden of advanced cervical cancer in women ≥65. Impact: Efforts should be made to better understand how the current screening paradigm is failing women of 65 years and older. Future work should focus on determining past screening history, lapses in follow-up care, and non-invasive testing approaches.

Trends in gynecological cancer incidence, mortality, and survival among elderly women: A SEER study

“…A study by Cooley et al. 15 delves into the prevalence of late‐stage cervical cancer in women aged 65 and older, a demographic often overlooked in screening guidelines. Analyzing data from the California Cancer Registry spanning 2009 to 2018, it reveals that a substantial proportion of older women present with late‐stage disease compared to younger counterparts, leading to lower survival rates.…”

Disparities in Gynecologic Cancers

“…Uninsured and publicly insured patients have a higher relative risk of late stage cervical cancer diagnosis than privately insured patients 12 . Disparities in age exist, as 20% are diagnosed at older than 65 years with worse survival outcomes 13 . Data are limited on whether these cases are due to new HPV infections, inadequate screening history, or lack of appropriate follow-up and whether current guidelines to stop screening after age 65 years need adjustment 14 …”

Region of origin and cervical cancer stage in multiethnic Hispanic/Latinx patients living in the United States

“…Socioeconomic inequities, as measured by variables such as median family income and poverty level, are thought to be a mediator of these findings 4 . Other studies have shown that disparities in screening and insurance status are associated with diagnoses of advanced‐stage cervical cancer among Hispanic/Latinx populations 6,7 …”

“…4 Other studies have shown that disparities in screening and insurance status are associated with diagnoses of advanced-stage cervical cancer among Hispanic/Latinx populations. 6,7 The U.S. Hispanic/Latinx population is the fastest-growing ethnic minority group and, by 2050, is expected to exceed a population of 102 million people from over a dozen countries of origin. 8 Health data for Hispanic/Latinx populations are typically presented in aggregate, which masks the population's significant heterogeneity.…”