Should women over 65 be screened for cervical cancer?

August 10, 2016

A study questions the existing guidance saying only women over 65 years who have risk factors should be screened for cervical cancer. Also, do placental syndromes increase the risk of cardiovascular disease? Plus: A look at Gardisil 9's safety profile.

Women aged 65 and older may have a lower risk of developing cervical cancer when they undergo routine Pap smear screenings, according to results from a new study, but many guidelines only call for the testing in women in that age group who have pre-existing risk factors.

Researchers constructed matched case-control data sets using the Surveillance Epidemiology End Results-Medicare database that looked at women who received care between 1991 and 1999 and were aged 65 and older. A total of 1267 cervical cancer cases were identified. Each single case was matched to eight controls, based on age and registry geographic location. Conditional logistic regression analysis was used to look at the association between gynecologic screenings and development of invasive cervical cancer.

More: Are you adhering to HPV co-testing guidelines?

The researchers found that having a Pap smear during the preinvasive detectable phase (2 to 7 years prior to diagnosis) had a significant negative association with development of invasive cervical cancer (odds ratio [OR] = 0.64, 95% confidence interval [CI] = 0.53–0.78). This was reduced after accounting for the estimated prevalence of hysterectomy among the controls (OR = 0.38, 95% CI = 0.32–0.46). The association was strongest for squamous tumors (OR = 0.48, 95% CI = 0.37–0.61). Restricting the subjects to women aged 72 or older did not affect risk.

The authors concluded that cervical cancer screening in women aged 65 and older reduced the risk of invasive cervical cancer, meaning that such testing in that population may be beneficial.

NEXT: Placental syndromes and cardiovascular risk

 

Placental syndromes and cardiovascular risk

Women with a pregnancy complicated by a placental syndrome may at increased risk for cardiovascular disease (CVD) over the short term, according to the results of a new retrospective study. Published in the American Journal of Obstetrics & Gynecology, the findings point to a need for strategies to lower CVD risk postpartum to improve future heart disease outcomes.

The goal of the analysis was to evaluate risk of CVD within 5 years of first pregnancy in women who had experienced a maternal placental syndrome. The researchers also looked at the impact of preterm birth (PTB) and delivery of a small-for-gestational-age (SGA) infant.

The retrospective cohort, from Florida, included more than 300,000 nulliparous women and girls aged 15 to 49 in their first pregnancy during the study period. None had a prepregnancy history of diabetes mellitus, hypertension, or heart or renal disease. The authors compared risk of subsequent CVD among those who did and did not experience a placental syndrome during the first pregnancy and then reassessed risk among women with placental syndrome and PTB or delivery of a SGA infant versus those without those pregnancy outcomes.

Recommended: What you need to know about cardiovascular disease in pregnancy

Among women and girls with any placental syndrome (11.8/1000), the rate of CVD was 39% higher than among those without a placental syndrome (8.5/1000). Risk of CVD was increased 19% (hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.07-1.32) among women and girls with any placental syndrome even after adjustment for sociodemographic factors, preexisting conditions, and clinical and behavioral conditions associated with the current pregnancy.

Risk of CVD was highest among those with >1 placental syndrome (HR 1.43; 95% CI, 1.20-1-70) followed by those with eclampsia/preeclampsia alone (HR 1.42; 95% CI, 1.14-1.75). The adjusted risk for CVD increased 45% (95% CI, 1.24-1.71) when placental syndrome was combined with PTB and/or SGA. Health care-related costs during follow up were increased 5-fold among women and girls with placental syndrome who went on to develop CVD, compared with those who did not develop CVD. 

NEXT: Is Gardisil 9 as safe as the quadrivalent HPV vaccine?

 

Is Gardisil 9 as safe as the quadrivalent HPV vaccine?

The 9-valent human papillomavirus vaccine (9vHPV) appears to be just as safe as the quadrivalent HPV vaccine (qHPV), according to results of a new analysis published in Pediatrics.

The study looked at the safety profile of 9vHPV, which was evaluated across 7 Phase III studies conducted in males, and in females who were not pregnant at time of entry, aged 9 to 26 years. The vaccines were administered in the standard 3-dose regimen on Day 1 and months 2 and 6. More than 15,000 study subjects received ≥1 dose of 9vHPV vaccine. In 2 of the studies, >7000 control subjects received ≥1 dose of qHPV.

Throughout the course of study, serious and nonserious adverse events (AEs) and any new medical conditions were recorded. Any women who tested positive for pregnancy on Day 1 were not vaccinated and those who became pregnant after Day 1 received no more vaccinations until resolution of the pregnancy. Pregnancies identified after the study start (n = 2950) were followed to their outcomes.

Next: HPV prevention update

The most common AEs (≥5%) experienced by those who received 9vHPV were injection-site AEs such as pain, swelling, and erythema, and vaccine-related systemic AEs like headache and pyrexia. Injection-site AEs were more common among 9vHPV recipients than among qHPV recipients and most were mild-to-moderate in intensity. Discontinuations and vaccine-related serious AEs were rare (0.1% and <0.1%, respectively). During the course of study, 7 deaths were reported, but none were considered related to the vaccine. The proportion of pregnancies with adverse outcomes were within the range of those reported in the general population.

The 9vHPV vaccine, the results of the analysis suggest, was generally well tolerated in the vaccine’s intended population with a safety profile similar to the qHPV vaccine. The investigators concluded that the additional coverage and similar safety profile support widespread vaccination using 9vHPV.