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Oral Health Assessment by Lay Personnel for Older Adults
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[Pap Smear after 65 years].

I Enderle1, F-A Le Baccon1, M Pinsard1

  • 1Département de gynécologie obstétrique et reproduction humaine, CHU Anne-de-Bretagne, 16, boulevard de Bulgarie BP 90347, 35203 Rennes cedex 2, France.

Gynecologie, Obstetrique, Fertilite & Senologie
|September 3, 2017
PubMed
Summary
This summary is machine-generated.

French cervical cancer screening recommendations suggest stopping at 65, but older women still face high risks of advanced cancers. Continuing screening or using HPV testing may be beneficial for this demographic.

Keywords:
Cancer du col utérinCervical cancerDépistageElderly womanFemme âgéeFrottis cervico-utérinHuman papillomavirusPap smearScreening

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Area of Science:

  • Gynecology
  • Oncology
  • Public Health

Background:

  • French guidelines recommend discontinuing cervical cancer screening (cervico-uterine smear, FCU) at age 65.
  • This organized screening is not yet universally implemented in France.
  • Invasive cervical cancer is more prevalent and aggressive in older women, with a poorer prognosis.

Purpose of the Study:

  • To evaluate the implications of stopping cervical cancer screening at age 65 in the French context.
  • To assess the risks and benefits of continuing screening or alternative testing methods for older women.
  • To identify subgroups of women over 65 who might benefit from continued screening.

Main Methods:

  • Review of French cervical cancer screening recommendations and implementation status.
  • Analysis of data on the incidence, stage, and prognosis of cervical cancer in elderly patients.
  • Examination of high-risk human papillomavirus (HPV) prevalence and lesion evolution in older populations.
  • Assessment of Pap smear (FCU) coverage rates and the protective effect of prior screening history.
  • Consideration of recent European studies on extended screening beyond age 65.
  • Evaluation of HPV testing as an alternative or exit strategy.

Main Results:

  • Despite recommendations, organized screening cessation at 65 is not generalized in France.
  • Older patients exhibit a higher proportion of invasive cervical cancers, which are more advanced and have a worse prognosis.
  • High-risk HPV infection remains prevalent in elderly women, with HPV-induced lesions showing a tendency for more aggressive evolution.
  • Pap smear (FCU) coverage is notably low in older age groups, increasing exposure to invasive cancer post-65.
  • Adequate screening prior to age 65 (≥2 normal Pap smears) is strongly associated with protection.
  • European data suggest the value of continuing screening beyond 65 due to increased longevity.

Conclusions:

  • Stopping cervical cancer screening at 65 may leave some women vulnerable, particularly those with inadequate prior screening.
  • Clinicians should consider continued screening for specific patient groups: those requesting it, with HPV history, fewer than 3 prior normal Pap smears, or co-existing conditions.
  • HPV testing presents a valuable option due to its high negative predictive value, suitable as an exit test or Pap smear alternative.