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
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