The burden of prevention: downstream consequences of Pap smear testing in the elderly

Sirovich, Brenda E.; Gottlieb, Daniel J.; Fisher, Elliot S.

doi:10.1258/096914103771773294

Cited by 15 publications

(3 citation statements)

References 33 publications

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“…Until recently recommendations from the US have been for women to be screened into their 80 s, and cervical screening over age 65 y is common [3],[4]. The current recommendation from both the American Congress of Obstetricians and Gynecologists and the American Cancer Society is that screening should be stopped at age 65 y for women with evidence of adequate prior negative screening and no history of cervical intraepithelial neoplasia grade 2+ [5],[6], but this recommendation was based only on expert opinion and modelling because of the lack of empirical data.…”

Section: Introductionmentioning

confidence: 99%

Cervical Screening at Age 50–64 Years and the Risk of Cervical Cancer at Age 65 Years and Older: Population-Based Case Control Study

et al. 2014

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Section: Introductionmentioning

confidence: 99%

Cervical Screening at Age 50–64 Years and the Risk of Cervical Cancer at Age 65 Years and Older: Population-Based Case Control Study

et al. 2014

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“…The lack of unanimity about CC screening in the elderly reflects the uncertainty regarding the cost-effectiveness ratio of Pap cytology within the postmenopausal (PMP) population 7. The efficacy of cytological screening is known to be lower in higher age groups, when compared with women aged 30–35 years, and is only effective in 20% of women aging 50 years or older 9.…”

Section: Introductionmentioning

confidence: 99%

A very rare case of HPV-53-related cervical cancer, in a 79-year-old woman with a previous history of negative Pap cytology

Zappacosta¹,

Lattanzio²,

Viola³

et al. 2014

CIA

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The introduction of organized cervical cancer (CC) screening programs has drastically reduced the prevalence of CC. However the incidence is still too high, especially among elderly women. All guidelines strongly recommend a regular Papanicolaou (Pap) testing for young and middle-aged patients. On the other hand, many international professional societies no longer advise screening in women who have undergone hysterectomy, and in women aged 65 years and above, who have a previous history of regular Pap smears. Here we report the case of poorly differentiated CC, involving the pelvic lymph nodes and urinary bladder, occurring in a 79-year-old woman who regularly underwent Pap tests, with no reported cytological abnormalities. In this very rare case, the CC cells, as well as cells from metastatic lymph nodes and cells from urinary specimens, molecularly showed human papilloma virus (HPV)-53. With the limitations of a single case, this report brings important information to prevent CC in elderly patients: the utility of molecular tests to increase sensitivity of Pap smears in postmenopausal women; the importance of HPV-53 as one of the four “emergent” genotypes having a possible role in oncogenesis; and the presence of HPV-53 in lymph node metastases from cervical carcinoma, which would support the role of this virus in the maintenance of malignant status.

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“…12,13 For example, in one study, two-thirds of American adults wanted a cancer screening test even when nothing could be done about the cancer if detected. 12 Overuse of screening tests (e.g., screening when there is no evidence that the test will benefit patient outcomes) have been reported for colorectal cancer, 14 cervical cancer, 15,16 and breast cancer. 17 One large, nationally representative study of the United States reported that 45% of older adults had been overscreened for colorectal, cervical, or breast cancer.…”

mentioning

confidence: 99%

The Impact of 4 Risk Communication Interventions on Cancer Screening Preferences and Knowledge

et al. 2021

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Purpose The US Preventive Services Task Force has changed their screening recommendations, encouraging informed patient choice and shared decision making as a result of emerging evidence. We aimed to compare the impact of a didactic intervention, a descriptive harms intervention, a narrative intervention, and a new risk communication strategy titled Aiding Risk Information learning through Simulated Experience (ARISE) on preferences for a hypothetical beneficial cancer screening test (one that reduces the chance of cancer death or extends life) versus a hypothetical screening test with no proven physical benefits. Method A total of 3386 men and women aged 40 to 70 completed an online survey about prostate or breast cancer screening. Participants were randomly assigned to either an unbeneficial test condition (0 lives saved due to screening) or a beneficial test condition (1 life saved due to screening). Participants then reviewed 4 informational interventions about either breast (women) or prostate (men) cancer screening. First, participants were provided didactic information alongside an explicit recommendation. This was followed by a descriptive harms intervention in which the possible harms of overdetection were explained. Participants then viewed 2 additional interventions: a narrative and ARISE (an intervention in which participants learned about probabilities by viewing simulated outcomes). The order of these last 2 interventions was randomized. Preference for being screened with the test and knowledge about the test were measured. Results With each successive intervention, preferences for screening tests decreased an equivalent amount for both a beneficial and unbeneficial test. Knowledge about the screening tests was largely unimpacted by the interventions. Conclusions Presenting detailed risk and benefit information, narratives, and ARISE reduced preferences for screening regardless of the net public benefit of screening.

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The burden of prevention: downstream consequences of Pap smear testing in the elderly

Cited by 15 publications

References 33 publications

Cervical Screening at Age 50–64 Years and the Risk of Cervical Cancer at Age 65 Years and Older: Population-Based Case Control Study

Cervical Screening at Age 50–64 Years and the Risk of Cervical Cancer at Age 65 Years and Older: Population-Based Case Control Study

A very rare case of HPV-53-related cervical cancer, in a 79-year-old woman with a previous history of negative Pap cytology

The Impact of 4 Risk Communication Interventions on Cancer Screening Preferences and Knowledge

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