Grand Rounds: How, when, and why to manage cervical dysplasia in adolescents

November 1, 2005

HPV infection is on the rise in teens and typically transient—yet it still raises the risk of dysplasia. The authors offer evidence-based yet practical guidelines for this management challenge.

The role of HPV

When to screen?

The goal of cervical cancer screening is to identify significant preinvasive lesions and prevent development of invasive cervical cancer. Age 18 has traditionally been accepted as the time to start cytologic screening, but recent consensus panels have recommended initiating screening later. The benchmark now is 3 years after the onset of sexual activity, but not later than age 21.12-14 This recommendation is based on the natural history of HPV infection and the rarity of cervical cancer in adolescents. The incidence of cervical cancer is 0 per 100,000 per year in girls aged 10 to 14 and 1.7 per 100,000 for those aged 15 to 19, according to the Surveillance, Epidemiology, and End Results database.15 Earlier screening is unlikely to add additional benefit and may lead to overtreatment of lesions that would spontaneously regress.