title: An evaluation of cervical cancer in women age sixty and over.
abstract: OBJECTIVE
  To assess prior cervical cancer screening, stage at time of diagnosis and outcome in women sixty years of age and over with cervical cancer.
  
  
  METHODS
  A retrospective review of cervical cancer patients evaluated at the University of Washington identified a cohort of women age sixty and older with cervical cancer diagnosed between January 1, 1993 and December 31, 2003. Electronic medical records and the University of Washington Tumor Registry were reviewed for age, ethnicity, cervical cancer risk factors, pathology, treatment, and outcome.
  
  
  RESULTS
  Six hundred forty-five women with cervical cancer were identified. One hundred (15.5%) women were age 60 or older with a median age of 64 years. At time of diagnosis, 41 were early stage (1A1-1B1) and 59 were advanced stage (1B2-4B). Length of time from last Pap smear significantly correlated with stage. Radical hysterectomy was performed on 29 patients, and 15 received adjuvant treatment. Forty-nine women received primary chemo-radiation, and 22 were treated with primary radiation. Lymph node metastases were identified in 65% of women with locally advanced cervical cancer. At conclusion of the study period, 80% were alive. Stage and time since last Pap smear correlated with overall outcome.
  
  
  CONCLUSIONS
  Women 60 and older make up a significant proportion of cervical cancer patients, often fail to receive screening, present with locally advanced disease, and tolerate standard treatment protocols. Careful consideration of these findings should be made when establishing Pap smear screening guidelines for this population of women.
authors.affiliation: Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington 98195, USA. kvfox@u.washington.edu
authors.forename: Katrina V
authors.initials: KV
authors.lastname: Fox
authors.forename: Chirag A
authors.initials: CA
authors.lastname: Shah
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Swisher
authors.forename: Rochelle L
authors.initials: RL
authors.lastname: Garcia
authors.forename: Lynn S
authors.initials: LS
authors.lastname: Mandel
authors.forename: Heidi J
authors.initials: HJ
authors.lastname: Gray
authors.forename: Ron E
authors.initials: RE
authors.lastname: Swensen
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Goff
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D065006:Papanicolaou Test; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D014626:Vaginal Smears