Clinical implications of screening for cervical cancer under Medicare. The natural history of cervical cancer in the elderly: What do we know? What do we need to know?

Article Abstract:

Medicare started to pay for Pap smears to screen for cervical cancer in July 1990, but problems related to the detection, diagnosis, and treatment of this disease in elderly women have not been solved. A review is presented of the current medical knowledge concerning these topics, with particular focus on the rate of disease progression; the proportion of noninvasive cases that will become invasive; the characteristics of the Pap test itself in the elderly; the rate of hysterectomy (removal of the uterus); and risk factors. When cervical cancer is diagnosed and treated in the preinvasive state, patient survival approaches 100 percent. Therefore, if the preinvasive state is long, Pap smears need be performed less often than if this period is short. However, the length of the preinvasive state has not been determined for women of any age. Different researchers have arrived at very different time estimates, ranging between one and nine years. Data concerning the proportion of cervical cancers that progress to a more malignant state also vary widely from report to report, but it is likely that findings indicating a more rapid disease progression among the elderly are valid. Certain anatomical changes in older women may complicate the process of obtaining the proper cells for the Pap smear, and some of the changes associated with normal aging may make the test's interpretation more difficult. Women who have undergone hysterectomy should not be excluded from cervical cancer screening; prior to the early 1960s, a cervical stump was left in place. It is not known if the incidence of cervical cancer in elderly women, whose reproductive lives ended before Pap smears became routine, is similar to that of younger women. Recommendations for screening should include the possibility of such potential variability. Mortality from cervical cancer declined by only 17 percent among women aged 50 or older between the 1970s and 1980s, compared with 43 percent among younger women. This lack of decline is partly the result of the omission of elderly women from screening programs, which are now possible with expanded Medicare coverage. Death due to cervical cancer is avoidable, even for older women. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Evaluation, Demographic aspects, Diseases, Aged women, Elderly women, Medicare

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Histologic classification and pathologic findings for endometrial biopsy specimens obtained from 2964 perimenopausal and postmenopausal women undergoing screening for continuous hormones as replacement therapy (CHART 2 Study)

Article Abstract:

Endometrial biopsies performed to detect possible cancer may not be necessary before initiating hormone replacement therapy. The endometrium is the inner layer of the uterus. Researchers performed endometrial biopsies on 2964 women who were either going through or had gone through menopause and who were candidates for hormone replacement therapy. The rate of endometrial cancer was 0.067%, indicating that endometrial biopsies may not be necessary before beginning hormone replacement therapy in women with normal good health. The women were 45-55 years old and may not be representative of other candidates for hormone replacement therapy.

Usage, Hormone therapy, Endometrium, Endometrial biopsy

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Screening for the major malignancies affecting women: current guidelines

Article Abstract:

Screening guidelines are presented for all the major cancers that affect women, including cervical cancer, endometrial cancer, ovarian cancer, colorectal cancer, and breast cancer. Gynecologists and obstetricians should be familiar with these guidelines since many women receive most of their care from OB/GYNs.

Colorectal cancer, Breast cancer, Ovarian cancer

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