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.

Keywords: Age; Cervical cancer; High-grade lesions; Low-resource settings; Screening.

Fig. 1

Graphical representation of the distribution of various cervical epithelial lesions among the three age bands: < 30 years, 30–65 years and > 65 years (squamous: cervical squamous lesions (total); ASC-US: atypical squamous cells—undetermined significance; LSIL: low-grade squamous intraepithelial lesion; ASC-H: atypical squamous cells—cannot exclude HSIL; HSIL: high-grade squamous intraepithelial lesion; SCC: squamous cell carcinoma; glandular: cervical glandular lesions (total); AGC-NOS: atypical glandular cells—not otherwise specified; AGC-N: atypical glandular cells—neoplastic)