DOI QR코드

DOI QR Code

Does Cervical Screening in Young Women Aged 20-25 Years Lead to Unnecessary and Harmful Interventions?

  • Al-Kalbani, Moza (Department of Obstetrics & Gynaecology, Sultan Qaboos University Hospital) ;
  • Price, John (Department of Gynaecological Oncology, Belfast Health and Social Care Trust) ;
  • Thompson, Gwen (Department of Gynaecological Oncology, Belfast Health and Social Care Trust) ;
  • Ahmad, Sarfraz (Department of Gynecologic Oncology, Florida Hospital Cancer Institute) ;
  • Nagar, Hans (Department of Gynaecological Oncology, Belfast Health and Social Care Trust)
  • Published : 2015.10.06

Abstract

Background: Cervical human papillomavirus (HPV) infection among young women (20-25 years of age) is common and normally transient. There are growing concerns that referral to a colposcopy clinic may lead to unnecessary treatment with an increased risk of obstetric complications. Therefore, the purpose of this study was to determine the level of intervention for cervical abnormalities in this age group of the Northern Ireland population. Materials and Methods: A review of all serial new patients under 25 years of age, who were referred to colposcopy clinics in Northern Ireland between January 1, 2009 to June 30, 2009 formed the basis of this study. Results: During the study period, a total of 4,767 women under 25 years of age were screened. Two-hundred-and-thirty-four (4.9%) cases were referred to the colposcopy clinics. The cervical cytology results were: high-grade abnormality in 35%, and low-grade abnormality in 31% of these cases. One-hundred-and-seventy-eight (76%) of the referred women received at least one treatment. One-hundred-and-twenty-one of 234 (51.5%) women underwent an excisional treatment with histology showing the presence of high-grade abnormalities (CIN2-3) in 52%, CIN1 in 28%, and Koilocytosis or normal tissue in 20% of this sub-group of cases. Conclusions: Screening women under the age of 25 years cause unnecessary referral for colposcopy. This may also result in considerable anxiety and psychosexual morbidity. It leads to an over-treatment with a potential of negative impact on the future pregnancy outcomes (including pre-term delivery, low birth weight, and pre-term premature rupture of membranes).

Keywords

References

  1. Leyden WA, Manos MM, Geiger AM, at al (2005). Cervical cancer in women with comprehensive health care access: Attributable factors in the screening process. J Natl Cancer Inst, 97, 675-83. https://doi.org/10.1093/jnci/dji115
  2. Luesley D, Leeson S (2010). Colposcopy and programme management: guidelines for the nhs cervical screening programme. NHS Cancer Screening Programmes (NHSCSP Publication No. 20).
  3. Moscicki AB, Shiboski S, Hills N, et al (2004). Regression of low-grade squamous intra-epithelial lesions in young women. Lancet, 364, 1678-83. https://doi.org/10.1016/S0140-6736(04)17354-6
  4. Nalliah S, Karikalan B, Kademane K (2015). Multifaceted usage of HPV related tests and products in the management of cervical cancer - a review. Asian Pac J Cancer Prev, 16, 2145-50. https://doi.org/10.7314/APJCP.2015.16.6.2145
  5. Rieck GC, Tristram A, Hauke A, et al (2006). Cervical screening in 20-24 year olds. J Med Screen, 13, 64-71. https://doi.org/10.1258/096914106777589551
  6. Sadler L, Saftlas A, Wang W, et al (2004). Treatment for cervical intraepithelial neoplasia and risk of preterm delivery. JAMA, 291, 2100-6. https://doi.org/10.1001/jama.291.17.2100
  7. Sasieni P, Adams J, Cuzick J (2003). Benefit of cervical screening at different ages: Evidence from the UK audit of screening histories. Br J Cancer, 89, 88-93. https://doi.org/10.1038/sj.bjc.6600974
  8. Sasieni P, Castanon A (2006). Call and recall cervical screening programme: Screening interval and age limits. Curr Diagnost Pathol, 12, 114-26. https://doi.org/10.1016/j.cdip.2005.12.006
  9. Sasieni P, Castanon A, Cuzick J (2009). Effectiveness of cervical screening with age: Population based case-control study of prospectively recorded data. Br Med J, 339, 2968. https://doi.org/10.1136/bmj.b2968
  10. Sjoborg KD, Vistad I, Myhr SS, et al (2007). Pregnancy outcome after cervical cone excision: A case control study. Acta Obstet Gynecol Scand, 86, 423-8. https://doi.org/10.1080/11038120701208158
  11. Tan L, Pepra E, Haloob RK (2004). The outcome of pregnancy after large loop excision of the transformation zone of the cervix. J Obstet Gynaecol, 24, 25-7. https://doi.org/10.1080/01443610310001620242
  12. Thaxton L, Waxman AG (2015). Cervical cancer prevention: Immunization and screening 2015. Med Clin North Am, 99, 469-77. https://doi.org/10.1016/j.mcna.2015.01.003
  13. Yang B, Morrell S, Zuo Y, et al (2008). A case-control study of the protective benefit of cervical screening against invasive cervical cancer in NSW women. Cancer Causes Control, 19, 569-76. https://doi.org/10.1007/s10552-008-9118-9
  14. Zappa M, Visioli CB, Ciatto S, et al (2004). Lower protection of cytological screening for adenocarcinomas and shorter protection for younger women: The results of a case-control study in Florence. Br J Cancer, 90, 1784-6.
  15. Demirtas B (2013). Review of strategies in promoting attendance for cervical screening. Asian Pac J Cancer Prev, 14, 3263-7. https://doi.org/10.7314/APJCP.2013.14.5.3263
  16. Ferenczy A, Choukroun D, Falcone T, Franco E (1995). The effect of cervical loop electrosurgical excision on subsequent pregnancy outcome: North American Experience. Am J Obstet Gynecol, 172, 1246-50. https://doi.org/10.1016/0002-9378(95)91487-0
  17. Fiander AN (2008). Cervical screening in young women aged 20-24 years. J Fam Plann Reprod Health Care, 34, 19. https://doi.org/10.1783/147118908783332104
  18. Gray NM, Sharp L, Cotton SC, et al (2006). Psychological effects of a low-grade abnormal cervical smear test result: Anxiety and associated factors. Br J Cancer, 94, 1253-62. https://doi.org/10.1038/sj.bjc.6603086
  19. Herbert A, Holdsworth G, Kubba AA (2008). Cervical screening: Why young women should be encouraged to be screened. J Fam Plann Reprod Health Care, 34, 21-5. https://doi.org/10.1783/147118908783332078
  20. Kyrgiou M, Koliopoulos G, Martin-Hirsch P, et al (2006). Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: Systematic review and meta-analysis. Lancet, 367, 489-98. https://doi.org/10.1016/S0140-6736(06)68181-6

Cited by

  1. The Prevalence of High-Risk HPV Types and Factors Determining Infection in Female Colombian Adolescents vol.11, pp.11, 2016, https://doi.org/10.1371/journal.pone.0166502