Cervical cancer screening strategies in women 65 years and older in the human papillomavirus era: A systematic review and meta-analysis of human papillomavirus-based testing and self-sampling approaches.
Ebru Zulfikaroglu
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In 30 seconds
This systematic review and meta-analysis assessed HPV-based cervical screening, including self-sampling, in women aged 65 years and older. Forty-five studies were included in the qualitative synthesis, with 13 contributing to meta-analysis of at least one outcome. High-risk HPV positivity and histologically confirmed high-grade lesions were found beyond conventional screening exit ages, particularly among women with incomplete prior screening. In a Danish catch-up initiative, uptake was ≈62% in the intervention region versus ≈2% in the reference region; CIN2 or worse detection was ≈3.9 per 1000 eligible women versus ≈0.3 per 1000, respectively.
Key findings
- In the Danish catch-up initiative, uptake was ≈62% in the intervention region versus ≈2% in the reference region.
- CIN2 or worse detection was ≈3.9 per 1000 eligible women in the intervention region versus ≈0.3 per 1000 in the reference setting.
- Clinically meaningful high-risk HPV positivity and high-grade lesions occurred beyond conventional exit ages, particularly in women with incomplete prior screening.
- Self-sampling, including messenger RNA-based approaches, appeared feasible and may address barriers related to postmenopausal anatomy and speculum discomfort.
Why it matters
The findings indicate that age alone may not capture cervical disease risk among older women, especially when prior screening is incomplete. They also suggest that screening access and participation depend on how invitations and testing pathways are designed. This evidence can inform consideration of targeted approaches while highlighting that the review does not establish a single optimal strategy for all women aged 65 years and older.
What to keep in mind
The evidence base was heterogeneous: 45 studies informed qualitative synthesis, but only 13 contributed to meta-analysis of at least one outcome. The abstract does not report pooled estimates for the main outcomes.