Cervical cancer is not just a young woman’s diseaseBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2729 (Published 15 June 2015) Cite this as: BMJ 2015;350:h2729
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Thank you for taking the time to comment on our article. We are not claiming that cervical cancer is not a young woman’s problem rather that it is not exclusively a young woman’s problem and the title reflects this.
We do not argue simply for an increase in the upper screening age. We suggest that it should be reviewed and kept under review as the population continues to age. Increasing the upper screening limit is one of several options we would like to see considered. One of these is to encourage those women currently eligible to attend cervical screening when invited.
Having said that, we do believe that the HPV test currently being piloted for primary screening brings along with it the potential for increasing the upper screening age limit effectively. This test introduces the potential for home self-sampling or less physically challenging sampling in the primary care setting which would make screening a more viable option for those older women who might experience considerable discomfort during the procedure.
As we report in the article, Elit’s (2014) literature review exploring cervical screening in older women reported that screening is beneficial until at least age 69 in terms of preventing occurrence of and death from cervical cancer. With the exception of the Castanon et al (2014) study the other studies reviewed found that the protective effect of screening in older women was up to around five years. This would make increasing the upper age limit imperative in a population of women who can expect to live on average nearly 19 years after the screening programme in the UK ends.
Importantly we are proposing that two approaches to cervical screening in older women are needed. The first is to increase the uptake of screening amongst women currently eligible. The other is to explore and keep under review options for increasing the upper age limit for screening. Further research is urgently needed to facilitate both approaches.
Competing interests: No competing interests
At the very outset we would like state that the title chosen by authors for the article is not appropriate. Susan Sherman and colleagues argued about the upper age limit for cervical screening and its needed revisit while claiming it to be not a younger woman’s problem. Authors indeed tried to provide an account to justify their case. If they refer to Great Britain’s statistics on Cervical Cancer (C53) with related European Age-Standardized Incidence Rates by Age, Females for 1975-2011, currently from the year 2006 onwards for the age group 25-49 years the incidence of cervical cancer is going to peak. Well there was a period from 1995 to 2006 where the incidence for 80+ was high.
The authors' views on the influence of life expectancy on cervical cancer appear to be reasonable but its increase is up to 5 years as reported from 78.2 to 82.7 in UK. This change as such should not advise any change on the upper age limit of cervical cancer screening. As clearly indicated by authors, there had been an observed decline in cervical screening uptake in the age group of above 55 years. Then obviously there can be definite reservations for women of more then age 65 years to attend cervical screening. The authors themselves mentioned some of these issues. Our study on factors influencing cervical cancer screening uptake indicated literacy as an important factor for older women above 55 years of age (1). Moreover, for developing countries, where the problem is rampant, there was advice of one life time cervical screening also.
In view of these facts, the augment of revisiting the upper age limit beyond 65 years for cervical cancer screening is not really going to yield any reasonable benefit. As the information provided by the authors shows, 48% of 50-80 year old women preferred self sampling HPV or had no preference. This very well shows the very reason for failure to take up or make use of the enhanced age of screening to 70 years even. After many years of accumulated evidence provided, for the current or existing age limits for cervical screening no change is necessary.
1. Asthana S, Labani S. Factors associated with attitudes of rural women toward cervical cancer screening. Indian J Community Med 2013;38:246-8.
Smita Asthana MD
Satyanarayana Labani* Ph D
Division of Epidemiology and Biostatistics
Institute of Cytology and Preventive Oncology (Indian Council of Medical Research)
I-7, Sector-39, Noida. UP
Competing interests: No competing interests