The Risk of Developing Cervical Cancer in the Elderly; Who Benefits From Screening After the Age of 60?

Objectives: Population-based cervical cancer screening in the Netherlands ends at age 60. This retrospective cohort study aims to identify a subgroup of people over 60 years who are at increased cervical cancer risk, and may benefit from extended screening.

Methods: People with a cervix, aged 59-61 with an abnormal exit smear (index smear), conducted as part of the screening program between 2000 and 2004, were identified from the Dutch nationwide pathology databank. A 1:3 matching was obtained with people without an abnormal screening smear at the same age. Incidence rate ratios (IRR) were calculated for the risk of developing cervical cancer or cervical intraepithelial neoplasia (CIN) later in life. Up to 22 years of follow-up was obtained.

Results: A total of 10,368 people were identified. The IRR for CIN and cervical cancer was increased for people with an abnormal index smear. This risk was highest for people with a high-grade index smear, compared with a normal index smear; IRR of high-grade CIN of 104.05 (95% CI = 38.18-353.18) and IRR for cervical cancer of 18.58 (95% CI = 5.31-61.07). The majority (82%) of people with an abnormal index test showed normal cytology or histology preceding their CIN or cervical cancer.

Conclusions: People with a cervix with abnormal cytology in their exit screening smear 59-61 years showed a 19 times increased lifelong risk of cervical cancer and more than 100 times increased risk for CIN. Because this increased risk was not limited to a specific timeframe, prolonged screening or adjusted diagnostic follow-up for this specific group should be considered.