Assessing high-risk human papillomavirus-based cervical precancer screening recommendations and implications among women aged 60/65 years and older in Ghana

Abstract

We aimed to assess the prevalence of high-risk HPV (hr-HPV) infection, cervical lesions observed through visual inspection, and abnormal cytology among women aged ≥ 60 years screened by the Cervical Cancer Prevention and Training Centre, Ghana. We further compared screening outcomes between women aged ≥ 60 and ≥ 65 years to assess the implications of applying these age cut-offs for screening cessation. Among 1,319 women screened, the overall mean ages were 66.7 and 71.2 years among ≥ 60- and ≥ 65-year-olds, respectively. The overall prevalence of hr-HPV infection was 27.9% (95% CI, 25.1 − 31.0), with a higher prevalence among ≥ 65-year-olds (30.8%; 95% CI, 26.6 − 35.2). Visual inspection ‘positivity’ rates were 1.9% (95% CI, 1.2 − 2.8) among ≥ 60-year-olds and 1.9% (95% CI, 1.0 − 3.2) among ≥ 65-year-olds. Cytology revealed ASCUS or worse lesions in 8.6% (95% CI, 1.8 − 23.1). Factors independently associated with hr-HPV infection among all women aged ≥ 60 included HIV co-infection (aOR, 4.12; 95% CI, 2.48 − 6.84), age (aOR, 1.03; 95% CI, 1.00 − 1.05), parity (aOR, 1.08; 95% CI, 1.02 − 1.14), and earning an income (aOR, 1.54; 95% CI, 1.10 − 2.15). In the ≥ 65-year-old subgroup, these associations were attenuated, except for HIV infection (aOR, 4.20; 95% CI, 2.07 − 8.49; p-value < 0.001). Among histopathologically-confirmed CC cases, 39.1% (95% CI, 31.7 − 46.8) were ≥ 60-year-olds, while 25.4% (95% CI, 19.1 − 32.7) were ≥ 65-year-olds. The study indicates a higher prevalence of hr-HPV infection among older women compared to community-dwelling younger women, with similar rates of cervical lesions on colposcopy. Given the increasing life expectancy in Ghana, the population of older women at risk for CC is expected to grow. Therefore, it is premature to recommend age-based cessation of cervical precancer screening in older women in Ghana. The context of limited access to screening and the opportunistic nature of screening, supports a more conservative approach to CC prevention among older women, particularly those living with HIV.