OBJECTIVE: The American College of Obstetricians and Gynecologists recommends cervical cancer screening for people with a cervix between the ages of 21 and 65 with cytology and human papillomavirus cotesting starting at age 30. These broad guidelines are intended to improve cervical cancer prevention and early detection but apply only to those with normal results. Surveillance guidelines for those with abnormal results are different and may not be widely followed. There is concern that older women and women of color may not benefit from these guidelines to the same extent as younger White women. To address a gap in the literature by conducting a retrospective cross-sectional study using the National Cancer Database to assess the relationship between age and race and late-stage cervical cancer diagnosis. METHODS: We conducted a cross-sectional study using data obtained from the National Cancer Database for the years 2004–2022. Women between 21 and 85 years of age with a known cervical cancer stage were included in this study. Age, race, and the combined effect of age and race were the exposures of interest. The outcome of interest was the diagnosis of late-stage (III and IV) compared with early-stage (I and II) cervical cancer. The association among race, ethnicity, and late-stage cervical cancer diagnosis was examined with multivariate-adjusted logistic regression models adjusted for insurance status, facility type, region, education, and income. A likelihood ratio test was used to test for the interaction between age and race. RESULTS: From 2004 to 2022, there were 102,131 early-stage (62.6%) and 61,076 late-stage (37.4%) cervical cancers in the National Cancer Database. Women 65 years of age and older had significantly higher odds of being diagnosed with late-stage cervical cancer (multivariate odds ratio OR MV 1.6, 95% CI, 1.5–1.7) compared with younger women; this was similar for all racial and ethnic groups. Non-Hispanic Black women had 16% (OR 1.2, 95% CI, 1.1–1.2) higher odds of a late-stage diagnosis of cervical cancer compared with non-Hispanic White women. Conversely, Hispanic (OR MV 0.8, 95% CI, 0.8–0.9) and non-Hispanic Asian/Pacific Islander (OR MV 0.9, 95% CI, 0.9–1.0) women had lower odds of a late-stage diagnosis compared with non-Hispanic White women. Non-Hispanic Black women 65 year of age and older had the highest odds of a late-stage diagnosis of cervical cancer compared with non-Hispanic White women 64 years or age or younger (OR MV 1.9, 95% CI, 1.7–2). CONCLUSION: These data support the hypothesis that women 65 years of age and older are at increased risk for late-stage cervical cancer compared with younger women. These findings suggest that the increased risk at later ages may be attributable to lack of adherence to screening guidelines or recommendations for surveillance and management of screening abnormalities. These findings have important implications for upstream structural drivers of these disparities and the need for equity-driven strategies that address the systemic barriers affecting older women across all racial and ethnic groups, especially non-Hispanic Black women.
Hsu et al. (Mon,) studied this question.