Nonsymptomatic carcinoma of the cervix in elderly women

I N 1927, Lane-Claypon analyzed the ages of 7,381 women with carcinoma of the cervix and found that the highest incidence occurred between the ages of 40 and 49 years. In his series, 8 per cent of cases were over the age of 60 years. Since then, Way in 1951, and Harnett in 1952, have produced series showing that the highest incidence of carcinoma of the cervix occurred between the ages of 50 and 59 years and that 26 and 29 per cent of cases were over the age of 60 years (Table I). These figures indicate that a shift has taken place in the age incidence of carcinoma of the cervix, and that over 25 per cent of cases are now in women over 60 years of age. The incidence of intraepithelial carcinoma in elderly women is difficult to estimate as the majority of surveys include women of all ages. It has been reported in women over 70 years of age,2 yet was not found in 600 women over the age of 60 years undergoing routine gynecological examinations.4 The following study was performed in order to determine the incidence of intraepithelial carcinoma and nonsymptomatic invasive carcinoma of the cervix in older women. Vaginal cytological smears were obtained from 3,168 postmenopausal women undergoing routine gynecological examinations between January, 1959, and January, 1964, at the J. J. Kane Hospital, Pittsburgh. This is a hospital for the treatment of chronically ill patients, the average age of whom is 75 years. The preparations were fixed and stained by the method of Papanicolaou and Traut and graded I through IV. Grade III was considered to be suspicious of malignancy while Grade IV was regarded as being definitely malignant. Patients with Grades III and IV vaginal smears were re-examined and fresh smears obtained. If the findings of the second preparation agreed with those of the first, the patient was transferred to the Magee-Womens Hospital, Pittsburgh, for a cone biopsy of the cervix, dilatation of the cervix and fractional curettage of the uterus. Forty-one of the 3,168 patients had Grades III or IV smears on initial examination. At the time of examination, 24 of these women had clinical evidence of malignancies including carcinoma of the cervix, carcinoma of the endometrium, carcinoma of the vulva, melanoma of the vulva, carcinoma of the rectum, and carcinoma of the bladder extending into the vagina. Eight patients with no clinical evidence of cancer, on re-examination had Grades I or II smears, and were considered to be free of malignancy. Two of the remaining 9 patients died of associated diseases before repeat vaginal smears could be obtained, and 2 who had Grade IV smears on re-examination died before cervical biopsies could be performed. The latter 2 were considered to have probable malignancies. Cervical biopsies on the remaining 5 women showed that 2 had intraepithelial carcinoma and 3 had invasive carcinoma of the cervix. The ages of the patients with intraepithelial carcinoma were 58 and 62 years. The women with invasive carcinoma were aged 63, 72, and 75, and the 2 women with cytologically diagnosed malignancies were 69 and 77 years of age.