A comprehensive analysis of cervical cancer screening data from more than 2.1 million women in China found that those aged 65 and older face a significantly higher risk of cervical disease than younger women. This result challenges the common practice of ending screening at age 65.
The study, conducted from 2017 to 2023 in Shenzhen, included women who were screened for high-risk human papillomavirus (hr-HPV) and cervical abnormalities. Although only 0.81% of participants were aged 65 and older, this group had markedly higher rates of hr-HPV infection, cervical intraepithelial neoplasia grade 2 or worse (CIN2+), and cervical cancer.
Led by Zichen Ye of the Chinese Academy of Medical Sciences and Peking Union Medical College in Beijing, the researchers reported that 13.67% of women aged 65 and older tested positive for hr-HPV, compared with 8.08% of younger women. The detection rate of CIN2+ in the older group was 3.33 per 1000—more than twice that in younger women (1.55 per 1000). Cancer detection was nearly 9 times higher among older women: 0.92 per 1000 vs 0.10 per 1000.
Older women also experienced more frequent infections with multiple high-risk HPV types. Among this group, CIN2+ was detected in 2.01% of women with single infections, 2.73% with double infections, and 4.04% with triple infections, showing a clear dose-response relationship between the number of hr-HPV types and risk of serious lesions.
Genotype distribution varied by age. In women aged 65 and older, the most common hr-HPV types were HPV52, HPV16, HPV56, and HPV58. The genotypes most associated with CIN2+ were HPV18, HPV16, and HPV33. Certain coinfections, such as HPV33/39, HPV35/31, and HPV18/39, were also linked to higher rates of cervical abnormalities in older women.
These findings raise questions about current screening guidelines that recommend stopping cervical cancer screening at age 65 for women with a history of normal test results, no history of cervical precancer, or a history of total hysterectomy for noncancerous conditions such as fibroids. World Health Organization guidelines suggest screening mainly between ages 30 and 49, but women between 50 and 65 years should be screened if they haven't been screened previously. "These guidelines account for the low benefits of continued screening in women aged 65 and older compared with potential harms like discomfort during sampling, false positives and unnecessary treatments," the authors wrote. However, they continued, the data suggest that older women remain at risk and may be more susceptible to persistent infections and disease progression due to age-related physiological changes.
Aging may make it harder to clear HPV infections as a result of reduced immune function and altered hormone levels. Postmenopausal changes can also complicate screening by affecting the visibility of cervical lesions.
The study calls for a reassessment of screening policies, especially in areas with low HPV vaccination rates and limited earlier screening coverage. Expanding screening to include older women based on individual risk factors—not age alone—may help reduce cervical cancer burden in aging populations.
As global life expectancy increases and HPV vaccination remains underused in many regions, the need for age-appropriate cervical cancer screening strategies becomes more urgent. Improved detection and treatment for older women could play a key role in lowering disease rates and improving outcomes worldwide.
The authors reported no conflicts of interest.
Source: GOCM