A 6-year experience with Pap smears in an urban adolescent practice: the scope and burden of abnormalities

Cervical Cancer Screening of Adolescents and Young Women: Further Evidence Shows a Lack of Clinical Value

STUDY OBJECTIVE

To assess the prevalence of cytological abnormalities among young people from a large population in the city of São Paulo (Brazil).

DESIGN

Retrospective, observational analysis of data from the institution's data processing center.

SETTING

A private laboratory in São Paulo (Brazil).

PARTICIPANTS

Comparison of 3 different groups (ie, adolescent women [aged ≤19 years], young adult women [aged between 20 and 24 years], and adult women [aged 25 years and older]).

INTERVENTIONS

Assessment of results from all cervical-vaginal smears collected for cytology between January 2010 and December 2015.

MAIN OUTCOME MEASURES

Comparative analysis of cytological abnormalities in the 3 different groups.

RESULTS

A total of 1,026,671 satisfactory cytology tests were performed. The proportion of cytological abnormalities was found to decrease with age (P < .001) and was similar in the groups comprised of adolescents and young adults, with 3.405/ 20.921 (16.3%) and 13,635/ 78,277 (17.4%), respectively, and 74,320/ 927,473 (8.0%) in the group of adult patients (P < .001). Among the positive cytologies in the group of adolescents, 3,331/ 3,405 (97.8%) represented low-grade lesions and 74/ 3,405 (2.2%) high-grade lesions, whereas among adults older than 25 years old, these figures were 69,092/ 74.320 (93%) and 5,228/ 74.320 (6.9%), respectively. No cases of cancer were found in the group of adolescents.

CONCLUSION

Cytological screening of young people is not recommended because of the low prevalence of high-grade cytological abnormalities in this population, with cancer being a rare event. This inadvertent screening could lead to unnecessary complementary exams and overtreatment, which could compromise the reproductive future of these young women.

The effect of age On cervical cancer screening in women aged 20-29

No definite consensus exists currently regarding the appropriate age at which to start cervical cancer screening. We analyzed the effectiveness of age in abnormal histology outcomes in women aged 20-29. Data on women aged 20-29 having undergone opportunistic cervical cancer screening with cytology during the 2014-2019 period were retrospectively reviewed. Based on cytology outcomes, human papillomavirus test results (if present), age and clinical decision, patients underwent either colposcopy or observation. The effects of age and other epidemiologic factors on histologic diagnoses of cervical intraepithelial neoplasia (CIN) or cancer [CIN (+)] were analyzed in univariate and binomial logistic regression analyses. Among 1649 women, CIN (+) lesions were observed in 61 (3.7%) women. The occurrence of CIN (+) lesions increased 1.149 times each year; thus, women aged 25-29 were more likely to have CIN (+) than those aged 20-24 (4.4% vs. 2.1%; p=0.019). A significant determinant of CIN (+) was the increase in age, i.e. women aged 20-29. Accordingly, considering age is crucial for the diagnosis of CIN (+) in cancer screening.

Cervical cytology screening among low-income, minority adolescents in New York City following the 2009 ACOG guidelines

OBJECTIVES

In December 2009, the American College of Obstetricians and Gynecologists recommended that cervical cancer screening begin at age 21 for young women. In this study, we examine receipt of first lifetime Papanicolaou (Pap) test and predictors of over-screening among adolescents within a large urban ambulatory care network.

METHODS

We compared the proportion of first lifetime Pap test of adolescents aged 13-20years between June 2007 - November 2009 (n=7700) and December 2009-June 2012 (n=9637) using electronic health records. We employed multivariable regression models to identify demographic and health care factors associated with receiving a first lifetime Pap test at age <21years in the post-guideline period (over-screening).

RESULTS

The proportion of Pap tests declined from 19.3% to 4.2% (p<0.001) between the two periods. Multivariable logistic regression results showed receiving care from gynecologic/obstetric/family planning clinics compared to pediatric clinics, having more clinic encounters, and older age were associated with over-screening in the post-guideline period.

CONCLUSIONS

We found that guideline adherence differed by clinic type, insurance status, and health care encounters. In the quickly evolving field of cervical cancer control, it is important to monitor practice trends as they relate to shifts in population-based guidelines, especially in high-risk populations.

Current guidelines for cervical cancer screening

PURPOSE

To provide evidence-based information that will guide nurse practitioners in instituting the most current cervical cancer screening recommendations.

DATA SOURCES

A literature search covering the years 2006 to the present conducted through Medline, CINAHL, and OVID.

CONCLUSIONS

Human papillomavirus (HPV) cervical infections are highly prevalent among females under 21 years, yet this age group has a low incidence of cervical cancer. For young women, 90% of HPV infections regress in 24 months, and, in longitudinal studies, no invasive cervical cancer was detected. HPV co-testing is effective for women age 30 and over.

IMPLICATIONS FOR PRACTICE

Current scientific evidence supports initiating cervical cancer screening for immunocompetent women at age 21, biennial screening between ages 21 and 29, and HPV DNA co-testing for women over 30. Nurse practitioners play an important role in integrating the newest guidelines into practice and improving the quality of healthcare regarding women's cervical health and cancer prevention.

Follow-up findings in young females with high-grade squamous intraepithelial lesion papanicolaou test results

CONTEXT

New guidelines discourage cervical screening and procedures in young females, given available human papillomavirus vaccines, concerns regarding procedure-associated harms, and the rarity of cervical cancers.

OBJECTIVE

To analyze histopathologic follow-up data on a large number of young females with high-grade squamous intraepithelial lesion (HSIL) Papanicolaou (Pap) test results.

DESIGN

Hospital records were searched for HSIL Pap test results in females 20 years or younger between January 2002 and December 2007. Histopathologic and Pap test follow-up, age group variations, and impact of Pap test transformation zone/endocervical sampling were analyzed.

RESULTS

Four hundred seventy-four females aged 20 years or younger had HSIL Pap test results during the study period. Three hundred thirty-five young females with at least one cervical biopsy were included. The average age was 18.6 years (range, 13-20 years). The average follow-up period was 24 months (range, 0.1-75 months), with a median of 22 months. Histopathologic detection rates were 44.2% for cervical intraepithelial neoplasia (CIN) 2/3 and 47.8% for CIN 1. The average period between the HSIL Pap test result and an initial diagnosis of CIN 2/3 was 5 months (range, 0.1-62 months), with a median of 2 months. Neither invasive carcinoma nor adenocarcinoma in situ was identified. Presence or absence of a transformation zone/endocervical sample did not significantly impact CIN 2/3 risk (44.5% versus 38.9%, P = .64).

CONCLUSIONS

Histopathologic CIN 2/3 was documented in 148 of 335 (44%) of biopsied young females with HSIL Pap results, likely reflecting both the reported high likelihood of HSIL regression in younger females and the challenge of colposcopic sampling of relatively short-lived smaller CIN 2/3 lesions. Although no cases of invasive carcinoma were identified in this study, updated guidelines pose new risks for maturing females with undetected cervical precancer.