Despite Guidelines, Many Older Women Are Still Screened for Cervical Cancer - Medpage Today

Despite recommendations against cervical crab screening for average-risk women ages 65 and older, much than 1.3 cardinal women successful the Medicare fee-for-service colonisation underwent screening successful 2019, with important costs, a cross-sectional investigation showed.

Although the wide proportionality of these women who received astatine slightest 1 cytology oregon quality papillomavirus (HPV) trial decreased from 1999 (18.9%), 8.5% inactive received 1 oregon some of these tests successful 2019, for a full expenditure of astir $83.5 million, including $7.4 cardinal for women older than 80, reported Jin Qin, ScD, of the CDC, and colleagues successful JAMA Internal Medicine.

However, whether these trends correspond overtesting is unclear, they noted. While continued investigating successful women implicit 80 "may correspond overuse," much than 41% of the cytology/HPV tests conducted successful 2019 were performed successful women ages 65 to 69, "suggesting that galore of these tests whitethorn person been performed to conscionable the criteria for screening cessation aft property 65 years."

"More in-depth probe of work usage aft property 65 years could amended elucidate whether they are indicated by women's screening and aesculapian past oregon whether they correspond overscreening," they added.

Since 1996, the U.S. Preventive Services Task Force (USPSTF) has recommended against cervical crab screening for average-risk women ages 65 and older who person had capable anterior screening.

In a commentary accompanying the study, Sarah Feldman, MD, MPH, and Stephanie Alimena, MD, some of Brigham and Women's Hospital and Harvard Medical School successful Boston, said that this investigation raised the question of whether the rates and costs of screening and prevention among the survey cohort was "too precocious oregon not precocious enough."

"Among the patients studied by Qin et al, it is imaginable that the identified costs are going to other investigating among those who bash not request it, portion determination whitethorn beryllium constricted oregon nary investigating among those who bash necessitate investigating due to the fact that of higher baseline risk," they wrote. "The astir cost-effective strategy would absorption connected helping each women person capable screening earlier property 65 years, documenting these results successful an accessible mode successful a nationalist physics wellness record, and past appropriately continuing surveillance for those women astatine higher risk."

In some 1999 and 2019, much than 15 cardinal women had Medicare fee-for-service coverage. The fig of women who received astatine slightest 1 cytology oregon HPV trial successful a calendar twelvemonth ranged from astir 3 cardinal successful 2002 -- 6 years aft the USPSTF issued its proposal -- to 1.3 cardinal successful 2019. Annual usage rates decreased from 18,925 per 100,000 women successful 1999 to 8,464 per 100,000 women successful 2019 -- a simplification of 55.3%.

Qin and squad besides analyzed yearly usage rates of colposcopy and cervical procedures, specified arsenic loop electrosurgical excision, cervical conization, oregon ablation, and recovered that these rates fell by 43.2% and 64.4%, respectively, implicit the survey period.

Trend analyses showed a 4.6% mean yearly simplification successful usage of cytology oregon HPV investigating from 1999 to 2019 (P<0.001), portion the wide age-adjusted yearly usage complaint of colposcopy and cervical procedures decreased by 3.0% and 5.3%, respectively, each twelvemonth connected mean from 1999 to 2019 (P<0.001 for both).

Qin and colleagues observed 2 chiseled trends successful cytology/HPV testing, with a 3.1% yearly alteration successful the play from 1999 to 2009, and a 6.1% yearly alteration successful the decennary spanning 2009-2019. And portion yearly usage rates of colposcopy and cervical procedures declined done 2015, they recovered that determination was a 2.8% summation among women ages 65 to 69 aft 2015.

When analyzed by contention and ethnicity, the age-adjusted yearly usage complaint of cytology/HPV investigating was highest successful achromatic women and lowest successful non-Hispanic American Indian/Alaska Native women. The age-adjusted yearly usage complaint of colposcopy was consistently higher successful Black women versus achromatic women, and Hispanic and Black women had a higher age-adjusted yearly usage complaint of cervical procedures compared with achromatic women, though these differences decreased implicit the survey period.

This population-based survey included 15,323,635 women ages 65 and older with Medicare fee-for-service sum successful 1999 and 15,298,656 successful 2019. In 2019, the mean property of the survey colonisation was 76.2; 5.1% were Hispanic, 0.5% were non-Hispanic American Indian/Alaska Native, 3.0% were non-Hispanic Asian/Pacific Islander, 7.4% were Black, and 82.0% were white.

Qin and squad acknowledged that they were incapable to relationship for chartless aesculapian past earlier property 65, including for women with antecedently diagnosed and treated pre-cancer, and for anterior hysterectomies.