Assessment of cervical cancer screening policy in Korea for women over age 65.
OBJECTIVE
The purpose of this study was to evaluate the efficacy of cervical cancer screening (CCS) in Korean women over 65 years of age and to determine the age at which CCS becomes inefficacious, so that providers and policy makers can be more informed about when to stop screening.


METHODS
The data of 999 women, who underwent CCS followed by colposcopy at the Korea University hospital from January 2007 to May 2012, were retrospectively evaluated. Age groups were classified as <21 (n=11), 21-29 (n=128), 30-65 (n=768), and >65 (n=92). To evaluate the value of CCS in women older than 65, age groups were simply divided into ≤ 65 or >65. Participants were also categorized into five strata of age groups (≤ 55 vs. >55, ≤ 60 vs. >60, ≤ 65 vs. >65, ≤ 70 vs. >70, and ≤ 75 vs. >75) that were compared to the sample to assess a cutoff-age at which to cease screening based on decreased efficacy.


RESULTS
The mean age was 45.5 ± 13.7 (range 14-80). There were no differences in the pathologic results for cervical intraepithelial neoplasia (CIN) values of < CIN2 vs. ≥ CIN2, or ≤ CIN3 vs. cancer among the groups. There was a significantly higher incidence of cancer compared with ≤ CIN3 in women aged >65 (13.0%) vs. ≤ 65 (6.6%), (p=0.037). To assess the cervical cancer incidence (CCI) from the larger number of cases by age, a prediction formula was calculated from a national dataset. CCI (per 100,000) continuously increased by age even for those in their 90 s.


CONCLUSIONS
CCS is still necessary in Korean women older than 65 since there is a substantial CCI rate occurring in these women. It is time to consider new guidelines that include the appropriate age and conditions for discontinuing screening.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea.
Sanghoon
S
Lee
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea.
Hyun Tae
HT
Park
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea.
Jin Hwa
JH
Hong
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea. Electronic address: yuni105@yahoo.co.kr.
Jae Yun
JY
Song
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea.
Jae Kwan
JK
Lee
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea.
Nak Woo
NW
Lee
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea.
Tak
T
Kim
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea.
Kyu Wan
KW
Lee
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000453:epidemiology
Age; Cervical cancer; Guideline; Policy; Screening