Cervical cancer in the older woman

OBJECTIVES: (1) To understand whether women who are older when diagnosed with cervical cancer have a poorer survival compared to those younger, and if so, to determine the relative importance of patient, tumor and treatment factors. (2) To review whether older women are candidates for aggressive curative treatment for their cervical cancer and the age related effectiveness and toxicity. METHODS: A review of the published English literature from 1990 to 2014 using search terms related to cervical cancer and older age was conducted. RESULTS: A number of confounders may influence whether advanced age impacts survival such as patient comorbidities, stage, histology, grade, no or incomplete treatment, less radical surgery, palliative rather than curative treatment, lack of adjuvant radiation after surgery, lower rates of chemotherapy and others. When older women are treated as aggressively as their younger counterparts, survival is the same; however, especially where radiation or chemotherapy is used, toxicities may occur at the same or slightly higher rate. CONCLUSIONS: The more recent population based studies have larger sample sizes and minimize the biases seen in single center studies. They have also corrected for confounders giving a more accurate answer concerning the outcomes of older women treated for cervical cancer. Performance status (or "frailty") and not chronologic age should define the optimal treatment strategy for older women with cervical cancer. Treatment related toxicities can be managed with treatment breaks or dose reductions. For those who receive curative treatment, the outcomes appear similar regardless of age.