Cervical Cancer Screening Patterns and Outcomes in Women Over 65 Years Old: A Retrospective Study of Medicare Patients

Objective: This study aimed to examine cervical cancer screening rates and adherence to national guidelines for cervical cancer screening in women over 65, identify demographic and clinical characteristics associated with appropriate screening, and describe screening outcomes in a single-site cohort. Methods: This retrospective study includes women over 65 who had a Medicare wellness visit and/or annual gynecologic visit from January 1, 2022 to December 31, 2022. Bivariate analysis was used to evaluate patient and provider characteristics associated with inappropriate and appropriate screening practices. Significant factors were combined into multivariable models to identify the most important predictors of screening practices. Results: Of 1,787 patients, 1,537 met the criteria for screening cessation, while 250 did not. Among high-risk women, only 5.2% were screened appropriately. Screening was less likely to be performed as age increased ( p <.001). Odds of appropriate screening in high-risk women were 6.7 times greater for those with a history of high-grade cervical dysplasia and 0.5 times lower with every 5-year increase in age over 65 years. Among the 82 women who underwent screening, 97.5% had normal cytology, and only 2.5% had abnormal cytology (ASC-US and ASC-H). Conclusion: Most women did not continue screening after the age of 65, including those defined as high-risk and/or not meeting the exit criteria for screening cessation. Providers should ensure that the criteria for screening cessation are met before ending screening. Additional studies are needed to develop strategies for identifying high-risk women during Medicare wellness visits.