Older women have the highest risk of dying from cervical cancer

New research from Aarhus University and Aarhus University Hospital shows that women aged 65 and older have a higher risk of dying from cervical cancer than previously thought -- although this age group is not covered by the Danish screening program.

Denmark has one of highest incidences of cervical cancer in the Western world. But once a person has turned 65, they are no longer automatically screened - even though older women are in fact those who have the highest mortality. This is shown by new research from Aarhus University and Aarhus University Hospital.

"Cervical cancer has become known as 'a young women's disease'. But it's a myth that it only affects young people. In fact, the mortality rate among women above the age of 65 is 25-30 per cent higher than previously thought," says medical doctor and postdoc Anne Hammer from the Department of Clinical Medicine, Aarhus University and Aarhus University Hospital.

She is behind the new study which has just been published in the scientific journal Acta Obstetricia et Gynecologica Scandinavia. The researchers looked at cervical cancer mortality rates in Denmark between 2002-2015 and found that the over 65s stood out here. For example, the mortality rate was five times higher among woman aged 75-79 compared to those aged 40-45.

Advanced cancer

The research results support a study from November 2018 in which Anne Hammer and her research colleagues found that older women were very often diagnosed so late that the cancer was already too big to be surgically removed. In such cases patients are instead treated with radiotherapy and chemotherapy - a treatment that is associated with side effects such as pain and urination and defecation discomfort.

More than half of the older women with cervical cancer who had followed the screening programme on a regular basis until it expired are diagnosed with cancer that is so advanced that surgery is no longer possible.

"When people are screened, the cancer can be discovered in its initial stages or at such an early stage that surgical treatment is still possible. This significantly reduces the risk of dying," says Anne Hammer.

Older women should also be screened

With the current rules, the screening programme stops if a person is tested negative between the ages of 60-64. According to Anne Hammer, there are plenty of grounds - especially with the new studies - to introduce initiatives to reduce the incidences and mortality from cervical cancer. This could for example be done by extending the screening programme.

"The negative test does not guarantee that someone won't get the disease after the screening ends, because the HPV virus which is the cause of the cancer can lie dormant in the body," says Anne Hammer. She also points out that there will very likely be fewer young women with cervical cancer in 5-10 years' time due to the HPV vaccine.

"But it will take many years before we see an effect among older women. When the society you live in has such a high incidence of advanced cervical cancer among older women with such a high mortality rate, then it is important to explore which interventions should be initiated to reverse this trend," says Anne Hammer, before adding that as long as the screening programme is not extended, the only thing to do is to keep a close eye on symptoms such as bleeding and altered discharge.

Abstract

INTRODUCTION:
We aimed to describe the cervical cancer mortality rates after correcting for hysterectomy and to evaluate trends over calendar time and by age.

MATERIAL AND METHODS:
Using data from nationwide registries, we calculated uncorrected and hysterectomy-corrected cervical cancer mortality rates among women age ≥20 years in Denmark during 2002-2015. We calculated hysterectomy-corrected rates by subtracting post-hysterectomy person-years from the denominator, unless hysterectomy was performed due to cervical cancer.

RESULTS:
The age-standardized hysterectomy-corrected cervical cancer mortality rate of 5.8/100 000 was 18.4% higher than the corresponding uncorrected rate. The hysterectomy-corrected cervical cancer mortality rate increased significantly with age, particularly in women aged 65+ (annual percent change +4.57), peaking at 26.1/100 000 person-years in women aged ≥85. The hysterectomy-corrected cervical cancer mortality declined significantly over calendar time, from 6.3/100 000 person-years in 2002 to 4.5/100 000 person-years in 2015 (annual percent change -0.22). This was mainly due to a significant decline in women aged 60 years and older, from 20.4/100 000 person-years in 2003 to 9.3/100 000 person-years in 2015 (annual percent change -0.75).

CONCLUSIONS:
The mortality of cervical cancer increased significantly by age, particularly among women aged 65 years and older for whom routine cervical cancer screening is not recommended. Understanding reasons for the high mortality rate in older women is critical, as this may help identify interventions needed to ensure a continued decline in cervical cancer mortality in older Danish women. 

Reference

Hammer A, Kahlert J, Gravitt PE, Rositch AF.  Hysterectomy-corrected cervical cancer mortality rates in Denmark during 2002-2015: A registry-based cohort study. Acta Obstet Gynecol Scand. 2019 Mar 13. doi: 10.1111/aogs.13608. [Epub ahead of print]

Content created April 2019