Cervical Cancer Screening: Is the Age Group 30–65 Years Optimum for Screening in Low-Resource Settings?

Abstract

Background

An Operational Framework document for population-wide screening of common cancers in India was launched in 2016. The target age for screening is 30–65 years for cervical, breast and oral cancers. This study was designed to review the frequency and distribution of cervical lesions among women aged 21–29, 30–65 and > 65 years.

Study Design

A retrospective review of all satisfactory cervical smears (n = 79,896) received over a ten-year period (2010–2019) was conducted. Three age bands were defined: 21–29 years, 30–65 years and > 65 years. The frequency and distribution of the various epithelial cell abnormalities (ECAs) across the three age bands were calculated. Cytohistologic correlation was performed wherever available.

Results

Of the 1357 ECAs (1.7% of all smears), about 16.9% were seen in the age band 21–29 years, while 4.5% presented in > 65 years of age. About 80% of the ECAs seen in younger women were low-grade squamous lesions, while 75% of lesions in women > 65 years were high-grade squamous abnormalities. Among the total 512 significant high-grade and malignant (squamous and glandular) lesions, 5.6% presented in women 21–29 years, while 10.1% were seen in > 65 years of age.

Conclusion

Majority of the significant cervical lesions would be detected if the screening focuses on the 30–65 years age group. However, about 19% of high-grade squamous preneoplastic lesions (ASC-H/ HSIL) and 13% of preneoplastic glandular lesions (AGC-N) are likely to be missed if women 21–29 years and > 65 years are excluded. The cost of screening incurred by including these age groups has to be weighed against the benefits derived, especially in low-resource settings. In the absence of universal implementation of HPV immunization, there is a felt need to enhance cervical cancer awareness and encourage screening, more so in high-risk category and symptomatic females beyond the selected age group.