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GUIDELINES/RECOMMENDATIONS 
A comprehensive analysis of 2.1 million Chinese women demonstrates significantly elevated cervical cancer risks in those aged 65 and older, with nearly 9-fold higher cancer detection rates and increased high-risk HPV prevalence compared to younger cohorts. These findings challenge current age-based screening cessation guidelines and suggest physiological changes may impair viral clearance in older women.
⚕️ Key Clinical Considerations ⚕️
- Statistical significance: Women ≥65 showed 13.67% hr-HPV positivity vs 8.08% in younger women, with CIN2+ detection rates of 3.33 vs 1.55 per 1000.
- Methodological strength: Large population-based study (n=2.1 million) with 6-year follow-up provides robust epidemiological evidence for policy evaluation.
- Dose-response relationship: Multiple hr-HPV infections correlated with increased CIN2+ risk (2.01% single, 2.73% double, 4.04% triple infections).
- Genotype-specific risks: HPV18, HPV16, and HPV33 most strongly associated with CIN2+ in older women, with distinct coinfection patterns.
- Age-related pathophysiology: Immune senescence and hormonal changes may compromise HPV clearance mechanisms and complicate screening interpretation.
🎯 Clinical Practice Impact 🎯
- Patient Communication: Discuss individualized screening decisions with women approaching 65, emphasizing that chronological age alone may not determine cancer risk cessation.
- Practice Integration: Consider extending screening beyond age 65 for high-risk patients, those with limited prior screening history, or immunocompromised individuals.
- Risk Management: Develop protocols for managing positive hr-HPV results in older women, accounting for increased false-positive rates and screening complications in postmenopausal patients.
- Action Items: Reassess current practice protocols for age-based screening termination and consider individual risk stratification approaches that incorporate vaccination history, prior screening results, and comorbidity status.
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