THE CASE FOR STOPPING CERVICAL SCREENING AT AGE 50

Objective To determine the pattern of abnormal cervical cytology in wo men aged 50 to 60 years and to determine whether the development of ce rvical neoplasia in this age group is confined to women who have been inadequately screened. Design Retrospective case analysis study. Popul ation An 11-year birth cohort of women in Grampian Region born between 2/10/33 and 1/10/44, and those who had significant cytological abnorm alities in the 5 year period 1/10/89 to 30/9/94. Main outcome measures Cytological and histological outcome for women with significant cytol ogical abnormalities between 50 to 60 years of age and the interval be tween three consecutive smears taken up to 50 years of age for those w omen. Results Of 23,440 women aged 50 to 60 years ever screened in Gra mpian Region, 229 (1%) had significant cytological abnormalities. Seve nty had CIN 3 and 15 had invasive disease of the cervix. Among approxi mately 9000 women with adequate smear histories prior to age 50, one c ase of CM 3 and one case of invasion were detected. The prevalence of invasive disease in the whole cohort during this five year period was 59/100,000. Among the previously well screened women the prevalence wa s 11/100,000. Conclusion The incidence of preinvasive disease of the c ervix is low over the age of 50 and is seen almost exclusively in inad equately screened women. There would appear to be little benefit in co ntinuing cervical screening over the age of 50 in women who have had r egular negative smears. The release of this low risk group from the ce rvical screening programme could alleviate anxiety and could enable re allocation of resources to target better high risk women who default f rom regular screening and to reduce screening intervals where necessar y to three years.