About ten years ago, Andrea Clay read online about the newly revised guidelines for cervical cancer screening.
A woman over the age of 65 who is at average risk of cervical cancer can stop taking the Pap test if she has been properly screened before, none of her health care providers mentioned. was not
but it is U.S. Preventive Services Task Force RecommendationsClay studied with the American College of Obstetricians and Gynecologists and the American Cancer Society.
Clay, a nurse and emergency medical technician in Edison, Washington, cheered quietly. In decades of screening, she had never had an abnormal pap result and was not in any high-risk group.
“I didn’t want to be a stirrup anymore,” she said. “I didn’t feel the need.” She printed out the guidelines and battled it out in case the nurse, her practitioner or doctor insisted on continuing screening. But no one did.
Now 74, she has not been screened for cervical cancer in several years. “I’m done,” she said.
But 70-year-old JB Lockhart, a retired office worker from Lake Oswego, Oregon, still plans his annual Pap.
Last year she changed to a new gynecologist. “She said she didn’t need to be tested anymore,” recalls Lockhart. “I thought you could get cervical cancer after a certain age.”
She told her doctor, “I’d rather be safe and take precautions.”
Lockhart cites the fact that task forces and medical groups only recommend screening for cervical cancer every three to five years (depending on which tests the patient undergoes), as well as the fact that some people have a certain number of normal results. Women stop at 65.
The Task Force’s ‘D’ rating for cervical cancer screening in older women means that there is “medium or high certainty that the service has no net benefit, or that the harm outweighs the benefit,” I never let her down.
Many other older women continue to undergo cervical cancer screening. Study at JAMA Internal Medicine report.
Researchers who surveyed 15 million women over 20 years using Medicare data found that the percentage of women who had at least one cytology or HPV (human papillomavirus) test increased from about 19% in 1999. We found that it dropped to 8.5% in 2019. I am concerned about overtesting and overtreatment of the elderly.
“We expected this trend,” said lead author of the study, Jin Qing, an epidemiologist in the Division of Cancer Prevention and Control at the Centers for Disease Control and Prevention. “But this size, this level, it’s a bit surprising, isn’t it?”
The guidelines state that women at average risk should have 3 consecutive negative cytology (Pap) tests or 2 consecutive negative HPV tests within the past 10 years (done concurrently with cervical cancer screening). ), and cervical cancer screening can be discontinued after the age of 65. ). The most recent negative test she must have taken within 5 years.
Women who have had a hysterectomy and have no previous precancerous lesions can also forgo screening.
“Many of my patients are overjoyed,” said Dr. Hunter Holt, a family physician at the University of Illinois at Chicago and study co-author. Not many people looked forward to removing their clothes and inserting a speculum so they could scrape off the cells.
However, in 2019, more than 1.3 million women aged 65 and over were still receiving screening and related services. 10% were over the age of 80, a particularly low-risk group. “With millions of patients, it quickly becomes costly for everyone,” says Dr. Qin. The study put him at $83.5 million in Medicare costs in 2019.
So are those who continue to be screened overtested? Not necessarily.
“It’s not good for all women to quit at 65,” said a gynecologic oncologist at Brigham and Women’s Hospital in Boston. editorial Accompanied by Dr. Hata’s research.
Some women are considered at high risk because they have a history of cervical cancer or precancerous lesions, or because they have a compromised immune system. Dr. Feldman says that screening will need to continue for the next 25 years. Women exposed to the drug diethylstilbestrol (DES) in utero are also thought to be at increased risk.
Other women should continue to be tested because they have not been tested enough before or because they are not sure when and how many times they have been tested. Some may not have been adequately screened because they did not have insurance and could not afford to be tested before they were eligible for Medicare.
Medicare records did not include medical history before age 65, so researchers were unable to determine the number of unnecessary tests. However, many studies have Many women do not get the recommended screening Before age 65 should not stop testing afterwards.
Dr. Feldman noted that about 20% of cervical cancers in the United States occur in women 65 and older. “It’s a preventable disease if you screen and treat the right people,” she said.
However, all screenings come with harm as well as benefits. Holt says that cervical cancer screening can have downsides, such as discomfort and emotional distress for victims of sexual abuse, especially as vaginal tissue thins with age.
Furthermore, “if we find something in the test, we have to deal with it,” he said. “Positive screening tests can lead to anxiety, stress and stigma.”
A positive result also leads to further procedures such as a biopsy, which includes a colposcope, a viewing instrument that enlarges the cervix. A biopsy can occasionally cause bleeding or infection, and often the results show that the patient does not have cancer or precancerous (although they may develop in the future).
False positives can also occur. Although data on screening outcomes for women over the age of 65 are scarce, Dr. Holt and several co-authors published her 2020 study. false positive rate For young women. According to their model, on average, a woman screened for her 15 years from age 30 would expect to have colposcopy once, perhaps twice, depending on the tests performed and frequency. will be
Sixty to 75% of these procedures showed no precancerous lesions or cancer, indicating that the initial test result was false positive.
It makes sense for women to discuss with their health care providers when to stop testing. Women over the age of 65 may have multiple sexual partners. increase the risk of cancerfor example, you may have a serious illness that is very likely to kill you before you get cervical cancer.
Researchers found that older people may be reluctant to forego cancer screening, regardless of what the guidelines say.
Dr. Mara Schoenberg, an internist at Beth Israel Deaconess Medical Center in Boston, has worked for years to help older women reduce unnecessary mammograms. Task Force does not recommend for people over 75citing insufficient evidence of benefit.
Developed by Dr. Schoenberg A brochure explaining the pros and consShe collected a sample of 546 women over the age of 75 and found that half of those who received the pamphlet were more knowledgeable and more likely to discuss mammography with their doctor. More than half of the people who read it got mammograms anyway.A similar “Decision support” could not be stopped senior from colon cancer screening.
General Internal Medicine Society do not recommend cancer screening For patients with life expectancy less than 10 years. However, life expectancy is a difficult concept to discuss with patients.
A survey of health care providers in California who screened low-risk women aged 65 and older for cervical cancer, despite knowing guidelines to the contrary, showed what could be difficult. Fifty-six percent of health care providers believed that stopping testing could cause them to miss a cancer diagnosis, but about the same number said that rather than explaining to patients why testing was unnecessary He admitted that it would have taken him longer to do the tests. 46% also reported ‘pressure’ from patients to continue.
Lockhart has his next Pap test scheduled for February. The office scheduler explained that another screening was not necessary, but Mr. Lockhart said he would continue anyway.
