3708 - The Burden of Cervical Cancer in Patient over 65: Identifying Systematic Failure and the Case for Extended Screening Guidelines

Purpose/Objective(s):

Cervical cancer screening guidelines generally recommend cessation at age 65 for patients with adequate prior negative screening. However, a significant proportion of invasive cases continue to occur in older populations. This study evaluates the relationship between age, healthcare engagement, and clinical stage at diagnosis within a large integrated system to determine if current age-based cessation guidelines contribute to preventable advanced-stage disease.

Materials/Methods:

We conducted a retrospective cohort study of women =18 years diagnosed with invasive cervical cancer between 2012 and 2024. Patients were categorized by their system engagement prior to diagnosis: "Engaged" (encounter 6 months to 5 years prior), "Unengaged" (no encounter within 5 years), or "New" (diagnosed within 6 months of system entry). Advanced disease was defined as FIGO Stage =2B. Using institutional tumor registry and EHR data, we analyzed predictors of late-stage diagnosis, specifically focusing on the impact of age =65 and the types of screening or follow-up failures encountered.

Results:

Of 1,132 patients identified, 52% (n=590) were engaged in care prior to diagnosis, while 30% (n=343) were unengaged and 18% (n=199) were new to the system. Among engaged patients, the primary points of contact were primary care (40%) and specialty care (43%), with only 12% engaging through OB/GYN.

On multivariable analysis, age =65 was a strong independent predictor of late-stage diagnosis, particularly for those patients who were engaged with the health care system (OR 1.68, p=0.016). Other significant predictors included high Charlson Comorbidity Index (CCI) (Category 3-6 associated with OR 2.1, p=0.0004) and the absence of screening within the prior 5 years (OR 2.1 p<0.0001). Notably, patients over 65 exhibited significantly lower rates of follow-up after an abnormal Pap smear (43%) compared to patients aged 18–29 (82%). Furthermore, there was a statistical trend toward an increasing proportion of patients diagnosed over age 65 throughout the study period (linear regression model, p = 0.078).

Conclusion:

In this large-scale analysis, age =65 was a strong and statistically significant predictor of advanced-stage cervical cancer at diagnosis. The lower follow-up rates for abnormal screening and the high rate of late-stage presentation in this cohort suggest that current screening cessation guidelines may leave older women vulnerable. These findings underscore the need to re-evaluate age-based screening limits and implement system-level alerts to ensure older patients receive adequate screening and diagnostic "rescue" within the primary care network.