Cervical cancer screening and the older woman: obstacles and opportunities

This article presents information on the incidence of cervical cancer among women aged 50 and older. Guidelines for screening for cervical cancer and recommendations on methods to overcome barriers to screening are discussed.

Although the Papanicoloau smear has been used for more than 30 years, invasive carcinoma of the cervix claims the lives of 5,000 women in the United States annually. Older women comprise 25% of patients with carcinoma of the cervix but 40% of the deaths. A disproportionate number of these patients present with locally advanced invasive cancer of the cervix, which explains the poorer survival of these women. Women older than the age of 65 with early stage disease enjoy disease-free intervals comparable to that of younger women. Stage of disease and not age appears to be a major predictor of survival.

There are marked differences in age with respect to the use of screening for cervical cancer. However, screening may have a significant impact on morbidity and mortality among older women. Educating patients of the importance of regular screening is paramount, but educating healthcare personnel is also an important component of reducing barriers to effective screening.