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Has the Incidence of Invasive Cervical Cancer in Older U.S. Women Been Underestimated?

May 12, 2014

Has the Incidence of Invasive Cervical Cancer in Older U.S. Women Been Underestimated?

  1. Andrew M. Kaunitz MD

Analysis that corrects for hysterectomy rates indicates risk in women older than 65 is higher than previously thought.

  1. Andrew M. Kaunitz MD

Hysterectomy is common in the U.S., and the vast majority of these surgeries involve removal of the cervix as well as the uterus. Because total hysterectomy protects women from future invasive cervical cancer (ICC), hysterectomy rates affect estimates of ICC incidence. Using national surveillance data, researchers calculated hysterectomy-corrected, age-specific incidence of ICC in U.S. women.

In contrast to the relative decline in uncorrected ICC rates with age, rates corrected for hysterectomy continued to rise after age 39, peaking among women aged 65 to 69. In addition, correction revealed greater disparity in ICC incidence between white women and black women, with the latter group having higher incidence than previously thought.

Comment

Current guidance (NEJM JW Womens Health Apr 12 2012) states that, in women older than 65 with adequate recent screening, further screening can be discontinued (because of low rates of invasive cervical cancer as well as high false-positive rates for cytologic changes reflecting atrophy of the lower genital tract in this population). Given that hysterectomy-corrected ICC rates in older women are substantially higher than the uncorrected rates underlying these recommendations, I agree with the authors of this analysis that the existing guidelines should be reviewed.

  • Disclosures for Andrew M. Kaunitz MD at time of publication Consultant / Advisory board Actavis plc; Bayer AG; Merck; Teva Pharmaceutical Industries Limited; UpToDate Royalties UpToDate Grant / Research support Trimel Pharmaceuticals Corp; TherapeuticsMD; NIH Editorial boards Contraception; Menopause; Contraceptive Technology Update; OBG Management; Medscape OB/GYN & Women’s Health Leadership positions in professional societies North American Menopause Society (Secretary)

Citation(s):

Reader Comments (2)

juan carlos castillo marin ruiz Fellow-In-Training, Obstetrics/Gynecology, Posgrado UNAM

la histerectomía subtotal (dejando el cuello) podría ser el motivo del incremento en la incidencia de Cárcer Cervico-Uterino

Jianna Tyrrell Physician, Obstetrics/Gynecology, public hospital

Interesting because in our caribbean population we are seeing ICC in our over 65 population even though they were screened earlier and advised to stop.

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