HPV: is it time to rethink screening in women over age 65?

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Takeaway

  • Findings indicate that a significant proportion of elderly women have persistent cervical HPV, placing them at continued risk for cervical cancer.
  • Although HPV prevalence may be relatively low, cervical dysplasia risk may be high with persistence.

Why this matters

  • Although US Preventive Services Task Force draft guidelines recommend against HPV screening in women aged >65 years, clinicians might consider ongoing, repeat HPV testing in postmenopausal patients.
  • Diagnostic conization is a preferable strategy for detecting precancerous or cancerous lesions in women with negative biopsies.

Key results

  • 4.1% of women (43/1051) were HPV-positive at first test (95% CI, 3.0-5.5).
  • At second test (on average 3.5 months later), 2.6% (n=27; 95% CI, 1.7-3.8) were still HPV-positive.
  • Among the 27 HPV-positive women at second test, 4 had atypical squamous cells of undetermined significance (n=1), or cervical intraepithelial neoplasia grade 1 (n=3).
  • No woman had a fully visible transformation zone at colposcopy.

Study design

  • Retrospective study investigating HPV prevalence and cervical dysplasia in women aged ≥60 years.
  • Funding: Center for Clinical Research (Dalarna, Sweden).

Limitations

  • Small sample size.
  • Potential cytology/histology sampling error.