Analysis

Cervical cancer is not just a young woman’s disease

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2729 (Published 15 June 2015) Cite this as: BMJ 2015;350:h2729
  1. Susan M Sherman, senior lecturer in psychology 1,
  2. Alejandra Castanon, epidemiologist 2,
  3. Esther Moss, consultant gynaecological oncologist3,
  4. Charles W E Redman, consultant gynaecological oncologist4
  1. 1School of Psychology, Keele University, Keele, Staffs ST5 5BG, UK
  2. 2Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, London, UK
  3. 3Department of Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK
  4. 4Department of Obstetrics and Gynaecology, Royal Stoke University Hospital, Stoke on Trent, UK
  1. Correspondence to: S M Sherman s.m.sherman{at}keele.ac.uk
  • Accepted 21 April 2015

Susan Sherman and colleagues argue that the upper age limit for cervical screening needs revisiting and call for awareness campaigns to target older as well as younger women

Cervical screening programmes in many countries stop at around the age of 65 and much of the focus is often on younger women. For example, recent media campaigns in England and Wales have centred on lowering the age at first screening. Comparatively little attention has been given to older women despite the fact that they account for about a fifth of cases each year and half of deaths.1 2 Of the 3121 women diagnosed on average each year between 2009 and 2011 in the UK, only 64 were younger than 25 compared with 616 who were older than 65.1 As the population ages, this number of older women affected is set to increase. We argue that screening programmes should reflect this.

Age distribution of cases

The raw statistics conceal the full impact of cervical cancer on older women. Although the absolute figures decrease with increasing age, when the rate of new cases per 100 000 women is considered, a second peak in diagnoses after the age of 65 becomes apparent (table). The case rate gradually decreases from 19.7 new diagnoses per 100 000 women aged 30-34 to a low of 8.6/100 000 women aged 65-69, but then rises again, reaching 12.5/100 000 in women aged 80-84. Furthermore, mortality data for the UK from 2010-12 show only seven deaths a year from cervical cancer in women younger than 25 but 449 deaths in women older than 65—nearly half of the total average deaths from cervical cancer in any year.2

View this table:

New cases (2009-11) of cervical cancer and deaths (2010-12) in UK by age

Although recent research by Castanon and colleagues suggests that women aged 65 who have had …

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