Highlights
- •Most women >65 years with cervical cancer were diagnosed at stage II or higher (63%), including 23% at Stage IV.
- •Nearly 15% of patients weren't treated, which was associated with age > 80, comorbidity scores ≥3, and stage IV disease.
- •5-year cancer-specific survival was 50% overall and treatment was associated with higher cancer-specific survival.
- •Increasing age and stage at diagnosis were associated with lower cancer-specific survival.
Abstract
Objective
Given that cervical cancer incidence rates do not decline in women >65, there is generally
limited screening, and these women have a poor prognosis, it is imperative to better
understand this population. We aim to describe the characteristics, treatment, and
survival of women >65 diagnosed with cervical cancer.
Methods
SEER-Medicare 2004–2013 data was used to describe 2274 patients >65 diagnosed with
cervical cancer. Five-year cancer-specific survival was estimated using the Kaplan-Meier
method. Multivariable Poisson and Cox regression analyses identified characteristics
associated with treatment and mortality.
Results
The median age was 76.1 years, with nearly one-third of cases occurring in women >80
years. Most patients were non-Hispanic White (64.8%), had comorbidity scores ≥ 1 (53.9%)
and squamous histology (66.3%). Most women were diagnosed at stage II or higher (62.7%),
including nearly one-quarter at Stage IV (23.1%). Nearly 15% of patients were not
treated (14.6%). Lack of treatment was associated with oldest age (>80), comorbidity
scores ≥3, and stage IV disease. Five-year cancer-specific survival was 50%. Increasing
age and stage at diagnosis were significantly associated with lower cancer-specific
survival whereas treatment was strongly associated with increased survival.
Conclusion
Most women >65 with cervical cancer are diagnosed with locally advanced or metastatic
disease and many do not receive treatment. Survival is improved with early-stage diagnosis
and treatment. These findings, coupled with the fact that women >65 constitute an
increasing proportion of the population, highlight the need to re-evaluate screening
and treatment practices in this population to detect cervical cancer at earlier stages
and increase survival.
Novelty and impact statement
In SEER-Medicare linked data from 2004 to 2013, most women >65 with cervical cancer
were diagnosed with locally advanced or metastatic disease. Both receipt of treatment
and survival decreased with increasing age. These findings, coupled with the fact
that women aged >65 constitute an increasing proportion of the population, highlight
the need to re-evaluate screening and treatment practices in older women to detect
cervical cancer at earlier stages and increase survival.
Keywords
Abbreviation:
SEER (Surveillance, Epidemiology, and End Results registry), AJCC (American Joint Committee on Cancer), CPT (Common Procedural Terminology), HCPCS (Healthcare Common Procedure Coding System), AC (adenocarcinoma), SCC (squamous cell carcinoma), HR (hazard ratio), RR (relative risk)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 01, 2022
Accepted:
January 10,
2022
Received in revised form:
January 8,
2022
Received:
November 2,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
