Do Women Over The Age of 65 Need Pap Smears?

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

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.

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.

Rositch AF et al., Cancer 2014 May 12

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