Current guidelines allow patients to discontinue cervical cancer screening at age 65 if they meet specific criteria, including a history of routine screening.  However, twenty percent of incident cervical cancers occur in patients over the age of 65, suggesting these patients discontinued screening prematurely.  The objective of this study is to characterize our population of older cervical cancer patients and to evaluate their screening history. 

A single-institution, retrospective analysis of cervical cancer patients who were diagnosed at or after age 65 was performed.  All subjects were diagnosed between 2012-2023.  Demographic, pathologic, and screening data were abstracted from the electronic medical record.  Descriptive statistics were used to characterize the population.

There were 90 patients who met inclusion criteria.  The median age at diagnosis was 70.6 years.  Most patients were diagnosed after presenting with symptoms (83.3%), most commonly vaginal bleeding (77.8%).  Few patients were diagnosed after an abnormal screening test (5.6%).  Most patients were referred to gynecologic oncology by an OBGYN (75.6%).  At diagnosis, 22.2% had localized (stage IA1-IB2), 60.0% had regional (IB3-IVA), and 17.8% had distant (IVB) disease.  The majority (76.7%) had squamous cell carcinoma.  While over one-third of patients (34.4%) reported no history of abnormal screening, 23.3% noted at least one prior abnormal screening test and 4.4% reported they had never undergone cervical cancer screening.  The median interval from last known Pap to cancer diagnosis was 10.5 years.The median PFS was 2.3 years, and the median OS was 3.6 years.  Specifics of these findings are outlined in table 1.

Current ASCCP guidelines suggest that cervical cancer screening can be stopped at age 65 if specific criteria are met, including 2-3 normal tests in the past 10 years and no history of severe dysplasia in the past 20 years.  However, we found that while our median population age was 70, the median time from last screening test to diagnosis was over a decade.  This suggests that providers may be discontinuing screening based on age alone, which is discordant with guidelines.  Further research is warranted to investigate barriers to cervical cancer screening in older patients to reduce the incidence of this preventable cancer.