Recalibrating Cervical Cancer Screening for Women Over 65 in the HPV Era
A new systematic review and meta-analysis evaluates human papillomavirus (HPV)–based cervical cancer screening strategies for women aged 65 years and older. The research, published in the International Journal of Gynecology & Obstetrics, finds that clinically meaningful high-risk HPV positivity and high-grade lesions persist beyond conventional screening exit ages, particularly among women with incomplete prior screening histories. The study highlights that targeted catch-up testing and well-designed self-sampling pathways, which can reduce barriers related to postmenopausal anatomy and speculum discomfort, may significantly improve coverage and detection of clinically relevant disease in this older population. Evidence from a Danish initiative showed a dramatic increase in uptake and lesion detection with an organized catch-up program, suggesting that risk-informed, HPV-based strategies should be reconsidered for extended-age screening.
Study Significance: For clinicians and public health planners focused on cervical cancer elimination, this evidence supports a shift towards personalized, age-adapted screening protocols. Integrating self-sampling for HPV testing into catch-up programs could address critical gaps in coverage for older women, directly impacting national screening program efficiency and long-term cancer prevention goals. This strategic pivot emphasizes moving beyond a one-size-fits-all exit age to a risk-based model that accounts for individual screening history and accessibility.
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