Introduction This study was to explore the prevalence and associated factors with high-grade lesions or cancer in women aged > 60 years with abnormal cervical cancer screening.

Methods Medical records of women aged > 60 years who had abnormal cervical cancer screening from 8 Thai cancer centers during 2009–2021 were retrospectively reviewed. Baseline characteristics, prior and current cervical cancer screening and subsequent histopathology were collected. Logistic regression analysis was performed to identify associated factors with high-grade lesions or cancer.

Results A total of 1,622 women were included. The mean age was 68.2±7.2 (range 60–100). Twenty one percent (251/1,175) were immunocompromised, 10% (55/511) still had sexual activity. Forty percent (527/1,293) had never had screening test. History of high-grade lesions or cancer were reported in 48.9% (128/262). The current abnormal screening results were normal cytology with positive high-risk HPV 0.9%, ASCUS 38%, LSIL 11.8%, ASC-H 11.9%, HSIL 12.6%, AGC 19.7%, SCCA 4.7% and adenocarcinoma 0.3%. Subsequent histopathology revealed high-grade lesions and cancer in 12.6% and 14.4% respectively. By univariable analysis, factors associated with high-grade lesions and cancer were older age, immunocompromised women, never had screening, and prior high-grade lesions or cancer. By multivariable analysis, the only independent significant factor was prior high-grade lesions or cancer (adjusted OR = 5.04, p<0.001).

Conclusion/Implications The risk of high-grade lesions and cancer in elderly women with abnormal cervical cancer screening was substantial. Continuing cervical cancer screening at age beyond screening recommendation should be considered especially in women with history of high-grade lesions or cancer.