May 6, 2011

Earlier Pap Smears Best for At-Risk Adolescents

Young women who have multiple partners or a history of sexually transmitted disease would benefit from cervical cancer screening before age 21, according to new research presented earlier this week at the annual meeting of the American College of Obstetrics & Gynecology.

“The patient population that we looked at is of lower socioeconomic status, they have a much earlier onset of sexual activity, higher rates of pregnancy and higher rates of sexually transmitted disease and all of these we know are risk factors for developing cervical cancer or abnormal Pap smears Dr. Amy M. Johnson from the University of Connecticut School of Medicine and Hartford Hospital told Reuters Health.

While it’s likely safe to delay the initiation of cervical cancer screening in the “vast majority” of young women until age 21, she added, the new findings suggest that ob-gyns should ask their young patients about whether they are sexually active and if so how many partners they’ve had.

Because cervical cancer rates are low among women under 21, the American College of Obstetricians and Gynecologists (ACOG) recommended in November 2009 that women begin having regular Pap smears at 21, rather than at 18 or within three years of starting sexual activity as had been recommended previously.

To investigate whether young women with risk factors for cervical cancer should be tested earlier, Dr. Johnson and her colleagues performed a retrospective case-control study of 394 patients who received cervical cancer screening at an inner city clinic.

Nearly 81% of the patients were Hispanic, Dr. Johnson said this week at the meeting in Washington, D.C. Their average age at their first PAP test was 17.

Eighty-two had moderate dysplasia (CIN2) and 37 had severe dysplasia (CIN3) before age 21. Those who reported having at least two partners were 4.5 times likely to have moderate or severe dysplasia, while patients with five or more partners had a 51-fold greater risk.

Moderate to severe dysplasia was also more common among young women with a history of sexually transmitted disease, with 42.1% having CIN 2 or CIN 3, compared to 22.8% of the patients with no STD history. The risk was particularly high among women with a history of Chlamydia (47.2% had moderate to severe dysplasia, compared to 22.6% of women with no history of Chlamydia infection) or genital warts (95.5% vs 63.6%, respectively).

“The current recommendation is to screen all sexually active girls for gonorrhea or Chlamydia under the age of 25 as part of their routine exam,” Dr. Johnson said. But if young patients test positive for either STD, or if they have a history of STDs, she added, “perhaps they should be someone that you start doing Pap smear screening on earlier.”

— Anne Harding, Reuters Health

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