Cervical cancers are still found in elderly women for several interconnected reasons related to biology, screening practices, and the natural history of the disease. Understanding why this happens requires looking at how cervical cancer develops, how it is detected, and what changes occur with aging.
First, cervical cancer is primarily caused by persistent infection with high-risk types of human papillomavirus (HPV), especially HPV-16 and HPV-18. HPV is a sexually transmitted virus that can cause changes in the cells of the cervix, sometimes leading to cancer over many years. While many HPV infections clear on their own, some persist and cause precancerous changes that can progress to invasive cancer if untreated. Importantly, HPV infections and the resulting cellular changes can remain dormant or undetected for decades before cancer develops. This means that an infection acquired earlier in life can lead to cervical cancer many years later, even after menopause and into old age.
Second, screening plays a crucial role. Cervical cancer screening programs, such as Pap smears and HPV tests, are designed to detect precancerous changes early so they can be treated before cancer develops. However, screening often stops around age 65 in many countries if previous tests have been normal. This age cutoff is based on the assumption that women with a history of normal screening are at low risk. But this is not always the case. Some women may have had undetected or untreated precancerous lesions that progress slowly and only become cancerous later in life. Others may have had limited access to screening earlier in life, especially in low-resource settings, so their risk remains high as they age.
Third, the immune system’s ability to control HPV infections and abnormal cell growth declines with age. Older women may have a reduced immune response, allowing latent HPV infections to reactivate or precancerous cells to progress unchecked. This immunosenescence means that even if HPV was acquired years ago and was dormant, it can become active again in elderly women, increasing cancer risk.
Fourth, symptoms of early cervical cancer are often absent or very mild, so the disease can develop silently. When symptoms like abnormal bleeding or pelvic pain appear, the cancer may already be advanced. Elderly women may attribute symptoms to other common age-related conditions or may not seek medical care promptly, leading to later diagnosis.
Fifth, certain risk factors that contribute to cervical cancer may persist or accumulate with age. These include smoking, which damages cervical cells; co-infections such as HIV that impair immune function; and socioeconomic factors that limit access to healthcare and screening. Additionally, historical exposures, such as to diethylstilbestrol (DES) in utero, can increase risk for rare types of vaginal and cervical cancers that may appear later in life.
Finally, demographic changes contribute to the continued presence of cervical cancer in elderly women. As life expectancy increases worldwide, more women live into older age, expanding the population at risk. In some regions, cervical cancer remains common due to limited screening and treatment infrastructure, so elderly women in these areas are more likely to develop the disease.
In summary, cervical cancers are still found in elderly women because HPV infections can persist or reactivate decades after initial exposure, screening often stops around age 65 leaving some lesions undetected, immune defenses weaken with age, symptoms may be subtle and overlooked, and risk factors accumulate or persist. The natural history of cervical cancer involves a long latency period, meaning cancers can develop many years after the initial HPV infection. This complex interplay of viral biology, aging, healthcare access, and screening practices explains why cervical cancer remains a concern in older women.
