Should Cervical Cancer Screening Begin at Age 21? A Quantitative Analysis
Daryoush Saeed-Vafa, Yajue Huang, Xinmin Zhang, Michael Carrozza, Varsha Manucha. Temple University Hospital, Philadelphia, PA
Background: In 2009 The American College of Obstetricians and Gynecologists recommended modifying the baseline cervical cancer screening age from the earlier of three years after first sexual intercourse or age 21 to age 21, regardless of the time of first sexual intercourse. In light of this recommendation, we evaluate whether Pap testing in women under the age of 21 in an urban high risk population group is necessary.
Design: The defined study group included women under the age of 21 who had their first abnormal cytologic diagnosis between 2001 and 2009. All subsequent cytologic and histologic diagnoses were recorded. Particular attention was taken of diagnoses occurring both before and after the subjects turned 21 years of age.
Results: A total of 2006 women aged 13 to 20 met the study criteria. Of these subjects, 92 (4.6%) were diagnosed with a high-grade squamous intraepithelial lesion (HSIL) prior to turning 21. Additionally, 1678 (84%) subjects had a cytologic diagnosis no greater than a low-grade abnormality [low-grade squamous intraepithelial lesion (LSIL) and atypical squamous cells of undetermined significance (ASCUS)] before turning 21, 13 of which developed HSIL after turning 21. Although not a specific category in the 2001 Bethesda System, 209 (10%) subjects were diagnosed, prior to turning 21 years of age, with a low-grade abnormality for which a higher grade lesion could not be completely excluded, 5 of which developed HSIL after turning 21.
A supporting histologic diagnosis, made prior to the subject turning 21, of CIN 2 or 3 was available for 32 subjects who had a diagnosis of HSIL prior to turning 21. A supporting histologic diagnosis, made after the subject turned 21, of CIN 2 or 3 was available for 7 subjects who were diagnosed with HSIL after turning 21, all of whom never received a diagnosis of either HSIL or CIN 2 or 3 prior to 21 years of age. Two subjects, both of whom had only a low-grade abnormality without a histologic diagnosis prior to turning 21, eventually developed invasive squamous cell carcinoma (21 and 25 years of age).
Conclusions: It appears that a substantial portion (15%) of abnormal cytologic diagnoses before the age of 21 are either HSIL or cannot completely exclude a high-grade lesion. Given the rate of progression of many of these lesions, our data suggests that active surveillance before the age of 21 in an urban high risk population group may yield a significant number of early diagnoses.
Tuesday, March 20, 2012 9:30 AM
Poster Session III # 53, Tuesday Morning