Routine cervical cancer screening typically ends after the age of 65 in the United States because cervical cancer rates have long been thought to plateau around menopause and decline thereafter. A recent study, however, explores age- and race-specific incidence of cervical cancer after correcting for hysterectomy prevalence-a factor that national cervical cancer incidence rates don't take into account-and shows a very different picture of the disease.

Rositch and colleagues collected data from the Surveillance, Epidemiology, and End Results program of the National Cancer Institute and estimated average annual trends in cervical cancer incidence from 2000 to 2009 in the United States before and after correcting for age-, race-, year-, and state-specific prevalence of hysterectomy. By removing from the equation women who no longer have a cervix and are therefore not at risk for cervical cancer (more than 98% of hysterectomies involve complete cervix removal), they found not only higher overall rates of cervical cancer but a shift in peak incidence to older women, as well as an increase in the disparity between black and white women.

Whereas uncorrected incidence rates of cervical cancer plateau at age 40 to 44 years (with 15.6 cases per 100,000 women), corrected data show a steady increase up to ages 65 to 69. What's more, after correction for hysterectomy the highest incidence rate is among 65-to-69-year-olds, at 27.4 cases per 100,000.

Race-specific disparities are even more stark: among black women, hysterectomy-corrected incidence rates increased with age, up to 53 cases per 100,000 among 65-to-69-year-olds. Whereas uncorrected data show a 62% higher rate of disease in black women than in white women, that disparity balloons to 89% after correction for hysterectomy.

The findings call into question the belief that cervical cancer is "fueled" by estrogen, causing risk to taper off after menopause, the authors write. They suggest a reevaluation of the current recommendation on the cessation of routine screening and underscore the importance of preventive measures, including a "broad uptake of prophylactic HPV vaccination in the United States."-Laura Wallis

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