Key takeaways:
- Women aged 65 years and older had significantly greater odds of being diagnosed with late-stage cervical cancer compared with younger women.
- Nearly half of cervical cancer cases in women aged 65 years or older were late stage at diagnosis.
- Non-Hispanic Black women experienced the greatest rates of late-stage cervical cancer among racial and ethnic groups studied.
- Private insurance was associated with a substantially lower risk of late-stage disease compared with Medicaid coverage.
- Findings underscore the need to address screening and surveillance gaps in older and underserved populations.
The odds of late-stage cervical cancer are increased in women aged at least 65 years, according to a recent study published in O&G Open.1
There were 13,960 diagnoses of late-stage cervical cancer and 4310 associated deaths reported in 2023, with a median age at diagnosis of 50 years. However, 20% of US women are aged over 65 years at cervical cancer diagnosis, despite current guidelines recommending screening be halted at this age if prior screening has been completed.
“Women diagnosed with cervical cancer after 65 likely do not meet recommended guidelines for discontinuation of screening or surveillance,” wrote investigators.
Cervical cancer assessments
The study was conducted to evaluate the influence of age and race on late-stage cervical cancer diagnosis. Data from 2004 to 2022 was collected from the National Cancer Database. Only incident cervical cancer cases were included. Patients receiving any cancer care at an accredited cancer program were recorded in the database.
Data extracted from the database included clinical and pathologic staging, number of lymph nodes evaluated, surgical margin status, tumor size, differentiation, and sociodemographic characteristics. Participants were aged 21 to 85 years, classified as either under 65 years or at least 65 years.
Race and ethnicity categories included non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, non-Hispanic American Indian, non-Hispanic Other, and Hispanic. Cervical cancer was determined by an endocervix, exocervix, overlapping lesion of cervix uteri, and cervix uteri anatomic site of the cancer’s origin.
Classifications of cervical cancer included stages 1 and 2 as the early stages and stages 3 and 4 as the late stages. Covariates included residence area, household income, insurance status, education, and facility type.
Higher rates of late-stage disease in older women
There were 163,207 cervical cancer patients included in the final analysis, 62.6% of whom were diagnosed with early-stage disease and 37.4% with late-stage disease. Late-stage disease was reported in 34.7% of women aged under 65 years vs 48.9% of those aged 65 years and older.
The most significant rate of late-stage cervical cancer was reported in non-Hispanic Black women at 43.8%, vs 36.7% in non-Hispanic White women and 34.8% in Hispanic women. Age of at least 65 years was also linked to increased odds of late-stage cervical cancer, with an odds ratio (OR) of 1.8 vs those aged under 65 years.
In non-Hispanic Black women, an OR of 1.3 was reported for late-stage cervical cancer risk vs non-Hispanic White women. Medicaid was also linked to an increased risk, with women who had private insurance reporting a 42% reduction in risk.
Implications
Overall, the most significant risk was reported in non-Hispanic Black women aged 65 years or older. This highlighted increased odds of late-stage cervical cancer from race and age.
“It is critical to identify and remove barriers to cervical cancer screening and surveillance of older women, especially those in minority groups for whom disparities in cancer risks and outcomes exist,” wrote investigators.
Expanding screening
Methods of boosting cervical cancer screening are available, such as federally qualified health centers (FQHCs), which were highlighted by Trisha Amboree, PhD, in an interview with Contemporary OB/GYN.2 According to Amboree, only 50% to 55% of FQHC patients are up to date on cervical cancer screening, highlighting an opportunity to strengthen these centers as pillars of health care.
Amboree recommended evidence-based interventions to expand screening capacity. These include technical assistance, increased funding, and workforce retention initiatives. A team-based approach is also vital, requiring every member of the clinical care team to actively encourage screening among their patients.
“If we were to improve screening in FQHCs, we would be able to reach groups that tend to have lower screening uptake, which would in general improve our screening in the United States as a whole,” said Amboree.
References
- Santos N, Kim J, Hsu K, et al. Association between race and age with cervical cancer stage. O&G Open. 2025;2(6):e138. doi:10.1097/og9.0000000000000138
- Amboree T. Trisha Amboree, PhD, highlights how FQHCs can boost cervical cancer screening. Contemporary OB/GYN. October 30, 2025. Accessed December 16, 2025. https://www.contemporaryobgyn.net/view/trisha-amboree-phd-highlights-how-fqhcs-can-boost-cervical-cancer-screening
