High prevalence of abnormal cervical smears in a hospital cohort of French women beyond the upper age limit screening program

- Cytological abnormalities rate is high in based-hospital elderly French women.
- Benign lesions are more detected at 66-75 years while pre-malignancies over 76.
- hrHPV prevalence is high and increases with severity of cytological abnormalities.
- HPV 16 is the most prevalent genotype in cervical cancer.
- In women with normal smears, incident CIN3 develops in HPV 16 + women.

ObjectiveTo determine the prevalence of cytological abnormalities and high risk Human PapillomaVirus (hrHPV) in cervical smears from French women aged over 65 years who attended the referent Gynecology Clinic of the Besançon University Hospital.MethodsBetween 2002 and 2012, 796 French women aged 66-99 years were cotested for cytology and hrHPV by Hybrid Capture 2 (hc2). hc2-positive cases were subjected to real time PCR for specific HPV 16/18/45 genotyping. Women with normal Pap smears and positive for hrHPV were followed-up every 12 months.ResultsCytological abnormalities were detected in more than 30% of women and cervical cancers (CC) in 2.9% of women. Benign lesions were more frequent in women aged 66-75 years while (pre)-malignant lesions were preferentially found in women over 76. The prevalence of hrHPV was 22.7%. HPV 16 was the most frequent (23.8%), followed by HPV 45 (7.7%) and HPV 18 (3.9%). The rate of hrHPV increased with the lesion severity and HPV 16 was identified in 50% of CC. Among the followed-up women, those who developed CIN3 were HPV16 positive at study entry.ConclusionThe study provides important estimates of the prevalence of cervical abnormalities and hrHPV positivity in a French hospital based-population over 65. Findings suggest to consider this high risk population in regards to cervical cancer.