Some Older Women May Benefit from ‘Catch-Up’ HPV Screening

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Women who go their whole lives without getting what’s known as “high risk” human papillomavirus (HPV) tests may still benefit from cervical cancer screenings after age 65, a new study suggests.

These high-risk tests have become more common in recent years because they can detect HPV, the virus that causes cervical cancer, at its earliest stages, before it’s possible to spot cervical tissue abnormalities (called lesions) with Pap smears, which has long been the standard screening method. Because high-risk tests are relatively new, most women over 65 years old have never had one, researchers noted in their study, published July 6 in the journal PLoS Medicine.

Catching Precancerous Cells Can Prevent Cervical Cancer

For the new study, researchers wanted to see if high-risk HPV tests might benefit women over 65 — a group currently not advised to get routine cervical cancer screenings.

Scientists invited more than 11,000 Danish women ages 65 to 69 to either get high-risk HPV tests at a doctor's office — where doctors insert a speculum into the vagina to facilitate swabbing the cervix for tissue samples — or to use less-invasive at-home HPV tests. Scientists also examined data on a control group of more than 33,000 similar women who didn’t get invited to screen.

“Providing women aged 65 to 69 without previous record of HPV-based cervical cancer screening — a catch-up HPV cervical cancer screening offer — has the potential to improve cervical cancer prevention at older ages,” says the lead study author, Mette Tranberg, PhD, a cancer epidemiologist at Randers Regional Hospital in Denmark.

Overall, about 62 percent of the Danish women in the study who were invited to get HPV tests did so within 12 months, compared with only about 2 percent in the control group. In the screening group, there were 3.9 cases per 1,000 women of precancerous cervical tissue identified, compared with just 0.3 cases for every 1,000 women in the control group.

It Can Take Years for HPV to Cause Cervical Cancer

This suggests that some cases of precancerous abnormal cervical tissue went undetected among the women who didn’t receive screening during the study, Dr. Tranberg says. It can take years for some types of HPV abnormalities to advance to full-blown cervical cancer, so it remains unclear whether catching precancerous abnormal cervical tissue would ultimately save lives.

“It is true that not all detected cervical precancer lesions would have progressed into cancer in the woman's remaining life span,” Tranberg says. “Therefore, the detection and treatment of these precancer lesions could be considered as overtreatment.”

In the United States, cervical cancer screening is recommended every three to five years among women 21 to 65 years old. The HPV vaccine is preventing cases in younger women, and is expected to help drive down the number of cervical cancer cases and deaths over time.

As an additional prevention strategy, the HPV vaccine is recommended for people of all genders as part of routine adolescent preventive care, for all adults up to 26 years old who didn’t get these shots when they were younger, and for certain adults up to 45 years old whose doctors think they may benefit, according to the U.S. Centers for Disease Control and Prevention (CDC).

As vaccination becomes more routine, the number of women infected with the HPV strains that are most responsible for cervical cancer has gone down, according to the CDC.

Healthy Older Women May Consider HPV Screening Up to Age 75

But many older women have never received the HPV vaccine, which is most effective when administered to people before they become sexually active and have the potential to be exposed to HPV during sex.

Nearly 1 in 5 new cases of cervical cancer diagnosed from 2009 to 2018 were in women 65 and older, according to a study published January 9, 2023, in the journal Cancer Epidemiology, Biomarkers & Prevention. These older women were more likely to be diagnosed with late-stage cancer than patients under 65 years old, and they had lower five-year survival rates.

Still, stopping HPV screening at 65 makes sense for women who have consistently received recommended screenings and have no history of abnormal test results over the previous decade, says Lindsay Locklar, a certified nurse midwife at Aurora Health Care in Oshkosh, Wisconsin.

Patients with a history of test results showing moderate to severe cervical lesions — and patients who haven’t completed recommended screenings — may wish to continue screening up to age 75, Locklar says. That’s especially true if they’re relatively healthy in their sixties, increasing the potential that treating any cervical lesions found on screening might help them live longer.

“If they’ve had normal and adequate screening, they can discontinue at 65 according to current U.S. guidelines,” Locklar says. “That said, for patients without serious health issues anticipating a long life expectancy, I feel it is reasonable to continue screening until 75.”

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