Researchers released new data this week suggesting that the rate of cervical cancer in U.S. women of all ages had been underestimated. Around 12,000 women in this country get the disease each year and 4,000 die from it. This has not changed, but the rate—which is expressed by saying how many out of 100,000 women will get the disease each year—has gone up by 55 percent in these new calculations because researchers stopped including women who’ve had hysterectomies.
A hysterectomy, or surgery to remove the uterus, also involves removing
a woman’s cervix. Though the number of hysterectomies performed in the United States has been declining recently, it is still estimated that more than 500,000 women get the surgery each year. These women had previously been included in the calculations despite the fact that they were no longer at risk for cervical cancer. Researchers believe the new numbers, which show that the same number of cases actually occurs among fewer women, provide a more accurate assessment of women’s cervical cancer risk at various ages.
Previous studies had estimated that the U.S. cervical cancer rate was about 12 cases per 100,000 women, that the highest rates were in women between ages 40 and 44, and that the incidence leveled off as women got older.
The new calculations show that there are 18.6 cases per 100,000 women of all ages and that the highest rates are actually in women 65 to 69. In fact, the rates for women in this age group jumped 84 percent (from 14.8 to 24.7 per 100,000 women) when women who’ve had hysterectomies were removed from the equation.
While this makes sense because the likelihood of hysterectomies increases with age, it suggests that the medical community may have been underestimating the risk of cervical cancer for older women who still have a uterus and a cervix. The other large jump was in the rate for African-American women, which went from 23.5 to 53 cases per 100,000 women, an increase of 126 percent. Again, the reason for this significant change is that African-American women have higher rates of hysterectomies overall.
Cervical cancer is a slow-growing cancer that can be treated early (even in precancerous stages) if detected. Screening tests for this cancer include the Pap test, which scrapes cells off the cervix. Cells are then looked at under a microscope to
determine cancerous or precancerous changes. A new generation of testing also uses cells scraped from the cervix to look for high risks strains of the human papillomavirus (HPV) , two of which—strains 16 and 18—are known to cause 70 percent of cervical cancers.
As of now, the American Congress of Obstetricians and Gynecologists (ACOG) recommends that women between the ages of 21 and 29 have a Pap test every three years and that women ages 30 to 65 have a Pap test plus HPV testing every five years. According to ACOG, women 65 and over do not need to be tested if previous testing was negative. These recommendations may change as a result of an FDA decision this month that allows health-care providers to use the HPV test instead of the Pap test, or along with it, for women of all ages. There’s also a chance that they may change because of the recent study, which suggests women, especially those over 65, are at more risk than experts had thought.
Anne Rositch, an assistant professor of epidemiology and public health at the University of Maryland School of Medicine and one of the authors of the study, said in a statement, “It will be important to consider these findings when reevaluating risk and screening guidelines for cervical cancer in older women and the appropriate age to stop screening.” She added that further research was necessary to determine “whether the continued increase in cervical cancer rates with age and the higher rates in African-American women represent a failure in our screening programs or a failure of the women to be screened so that appropriate interventions can be applied.”
While more research is being done and medical organizations like ACOG reevaluate the recommendations, women should work with their doctors to assess their own risk and develop a
screening plan. Dr. Tara Shirazian, a gynecologist at Mt. Sinai Hospital in New York City, told CBS News, “I think risk factor-based assessment needs to be done for every patient. So every woman that comes to see me in the office we do an individual risk assessment. Has she ever had an abnormal pap smear, does she have HPV? Has she ever had HPV? Has she ever had any surgery to the cervix from HPV-related disease? Those sorts of things should go into continued monitoring of the individual woman for cervical cancer.”
Of course, the most important thing is that women continue to seek gynecological care even as they age. Younger women should also consider getting the HPV vaccine, which is available to those ages 9 to 26 and has been shown to dramatically reduce the risk of contracting the HPV strains most likely to lead to cervical cancer.