The American College of Obstetricians and Gynecologists recommends that women begin Pap test screening at 21 years, but are there certain circumstances in which Pap tests are warranted at younger ages? Dr Amy M. Johnson of Hartford Hospital in Connecticut and colleagues hypothesized that teenage girls who engage in risky behaviors would benefit from early initiation of cervical screening.
The American College of Obstetricians and Gynecologists recommends that women begin Pap test screening at 21 years, but are there certain circumstances in which Pap tests are warranted at younger ages? Dr Amy M. Johnson of Hartford Hospital in Connecticut and colleagues hypothesized that teenage girls who engage in risky behaviors would benefit from early initiation of cervical screening. They presented their findings at the 59th Annual Clinical Meeting of the American Congress of Obstetricians and Gynecologists.
Johnson and colleagues conducted a retrospective case control study of 394 patients who attended an inner city resident clinic. Charts were analyzed for information pertaining to demographics, sexual history, substance abuse, pregnancy status, and sexually transmitted disease (STD) history. The majority of the patients were Hispanic (80.7%). On average, the young women received their first Pap test when they were 17 years.
Based on the chart data, Johnson and colleagues found that almost one third of the patients had moderate (CIN 2) to severe dysplasia (CIN 3) prior to 21 years (Figure). They also found that the number of partners reported by the patients was related to increased risk. Specifically, women who reported at least 2 partners were found to have 4.5 times increased risk of moderate to severe dysplasia as compared to those women who reported only one prior partner. Furthermore, those patients who reported more than 5 sexual partners were found to have 51 times the risk of CIN 2 or CIN 3.
Figure. Dysplasias found in adolescent patient sample.
Johnson and colleagues also found an association between sexually transmitted disease and dysplasia, with adolescents having any STD more likely to have dysplasia (44% vs 27%). Specifically, the researchers found that patients with genital warts had a higher risk of dysplasia in general (8% vs 0.7%). They also found that those adolescents with a history of chlamydia had a higher risk for moderate to severe dysplasia (48% vs 23%).
Since Pap tests can be an effective means for early detection and treatment and result in better outcomes for patients, the results of this study indicate there might be occasion for clinicians to consider administering Pap screens to certain younger patients. Based on these findings, Johnson and colleagues concluded: “Adolescents with multiple sexual partners and STDs may be candidates for early Pap smear screening.”
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Johnson AM, Gruessner L, Bierauge K. Is there a subset of high risk adolescents who should undergo Pap screening prior to age 21? ACOG Annual Meeting. Poster 118. April 30, 2011.