How to prevent cervical cancer in older women

This is the 5080th article of Da Yi Xiao Hu

The advent of the cervical cancer human papillomavirus (HPV) vaccine has made cervical cancer the first tumor that can be eliminated. However, since its advent, it has been very unfriendly to older women, who feel like a neglected group. The 2-valent vaccine and the 4-valent vaccine are both for women aged 9 to 45, while the 9-valent vaccine was initially for women aged 16 to 26. Although my country will expand the age of the 9-valent vaccine in August 2022 so that more women can be vaccinated to prevent cervical cancer, the final expanded age is only 45 years old. Don't older women get cervical cancer? Do they not need to prevent it?

In fact, this is not the case. Although cervical cancer is more common in women of childbearing age and those who are sexually active, older women can also be infected with high-risk HPV and therefore may also get cervical cancer. Some older women are often afraid of gynecological examinations due to menopause or reproductive tract atrophy. Some women also ignore cervical cancer screening because they think they will not be infected with HPV or get cervical cancer if they do not have sex because of reduced sexual activity after menopause. Therefore, once symptoms appear (such as irregular vaginal bleeding, bleeding during intercourse, irregular vaginal discharge, etc.), when they seek medical treatment again, lesions or cancer have often already occurred. So, how can we effectively prevent this group of people?

In fact, in our three-level prevention strategy for cervical cancer, in addition to cervical cancer vaccination as primary prevention, secondary and tertiary prevention are applicable to older women. The secondary prevention mentioned here is cervical cancer screening, which plays a key role in cervical cancer prevention as a secondary prevention measure. For people at high risk of cervical cancer or those who have not received cervical cancer vaccination, it is recommended to do cervical cancer screening every year or every two years, including cervical cytology and HPV testing. For those with abnormal cervical cytology or high-risk HPV positive, further colposcopy or cervical biopsy should be performed to screen out cervical precancerous lesions in time. The tertiary prevention is to remove the precancerous lesions through surgery, laser, freezing, etc. before they develop into cervical cancer for people with cervical precancerous lesions found in the screening, so as to block their development into cervical cancer. Therefore, for older women who cannot receive the HPV vaccine, there is no need to be afraid of cancer or worry about the HPV vaccine, because the development of cervical cancer is a gradual and relatively slow process. Even if infected with high-risk HPV, it does not mean that you will definitely get cervical cancer. Regular screening can detect early lesions, and early intervention can block the development of cervical lesions. For older women with persistent or repeated high-risk HPV infection, keep paying attention and have regular check-ups. At the same time, by establishing a good lifestyle, such as safe and healthy sexual behavior, timely treatment of reproductive tract infections, quitting smoking, and strengthening physical fitness, you can avoid or reduce HPV infection.

Here we need to remind those elderly women who have not been treated for cervical cancer for a long time that they are advised to go to the hospital for screening. Once they are infected with high-risk HPV, there is no need to panic. They should have regular check-ups and, if necessary, a colposcopy to rule out the presence of cervical lesions.

Author: Department of Gynecology, Huadong Hospital, Fudan University

Zhu LihongDeputy Chief Physician