Extending the upper age limit: Evaluating cervical screening outcomes in women aged ≥65 years

INTRODUCTION: This study aimed to evaluate the clinical significance of cervical cytology in women aged ≥65 years and to identify high-risk subgroups who may benefit from extended surveillance in the absence of a national screening protocol.

METHODS: This retrospective study reviewed 1,661 cervical cytology specimens obtained from women aged ≥65 years at a tertiary academic center in Türkiye between January 2020 and March 2024. Among these, 36 specimens (2.2%) showing abnormal or indeterminate findings were analyzed in detail, whereas negative smears were documented but excluded from further evaluation. Demographic data, comorbidities, prior screening history, human papillomavirus (HPV) status, and histopathologic outcomes were collected.
RESULTS: Abnormal cytology was identified in 2.2% of all specimens. More than half of these women (52.8%) had inadequate or absent prior screening. High-grade squamous intraepithelial lesions (HSIL) and glandular abnormalities (AGC/AGUS) comprised 33.3% of abnormal cytology cases (12/36), while Cervical intraepithelial neoplasia (CIN 3)+ or malignancy (including cervical and non-cervical) was confirmed in 12 of 36 women (33.3%). HPV testing was performed in only 25% of cases due to limited availability. Diabetes mellitus was more frequent among women with advanced lesions.
DISCUSSION AND CONCLUSION: Although abnormal cytology was uncommon in this age group, clinically significant lesions, including CIN 3+ and invasive cancers, were still detected. These findings suggest that women with insufficient prior screening or relevant comorbidities may benefit from an individualized, risk-based approach incorporating prior screening history and clinical characteristics, rather than a strictly age-based cessation strategy.

Keywords: Cervical screening, abnormal cytology, upper age limit