Cancer Screening and Early Detection Among Ageing Women: Should Practice or Policy Change?

Australian health authorities recommend cessation of Pap smear screening at the age of 70 years for women who have had two normal Pap smears within the last five years. Pap smear screening should be initiated for women over 70 years of age who never have been screened. Mammographic screening is recommended for women 50–70 years. All adults over 40 years of age are advised to check for rectal blood after every bowel motion. This study was conducted to determine current compliance with these guidelines in an ageing female population, using a self‐administered questionnaire. A 94% response rate resulted in 414 completed questionnaires from women aged 60 to 99 years (median 81). Of women over 70 years with intact uteri, 40% never had had a Pap smear. Twelve percent of women over 70 had had a recent screening mammogram. In total, 21% of respondents checked the toilet bowl every time they passed a bowel motion and 27% checked the toilet paper every time. These results demonstrate that cancer screening and early detection practices among ageing women are varied. In contrast to current policies, cervical cancer screening is not always initiated for women over 70 years who never have been screened. Further, mammographic screening continues beyond 70 years of age although there is no evidence of benefit for these older women. Too few studies have been conducted to ascertain the benefits, acceptability and unintended negative sequelae of cancer screening activities in ageing women. Research is required to inform and, if necessary, revise screening policies and clarify the preventive messages promulgated to the elderly and their health care providers.