Abstract
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. 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. 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. 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).
Highlights
There has been growing interest in the cervical screening in recent years worldwide (Demirtas, 2013; Nalliah et al, 2015; Thaxton and Waxman, 2015)
A review of all serial new women (n=4,767) under the age of 25 years old who were screened and a total of 234 (4.9%) cases were referred to the colposcopy clinics in Northern Ireland between January 1, 2009 to June 30, 2009 was performed
Of (4.9%) cases were referred to the colposcopy clinics, those who were referred to the colposcopy clinic, more indication being abnormal cervical smear
Summary
There has been growing interest in the cervical screening in recent years worldwide (Demirtas, 2013; Nalliah et al, 2015; Thaxton and Waxman, 2015). In 2003, the English National Health Service Cervical Screening Programme (NHSCSP) recommended cervical screening to young women aged 25 years and over (Luesley and Leeson, 2010) This recommendation was based on the growing evidence that cervical smear abnormalities are more common in sexually active women in this group, especially human papillomavirus (HPV) changes. Studies have shown that there was no evidence that screening of women aged 22-24 years reduces the incidence of cervical cancer as compared to the age 2529 years, thereby concluding that there was no benefit of cervical screening in this group of women (Sasieni et al, 2009) Unnecessary treatment in this group of women could lead to negative consequences on women’s childbearing potentials (Kyrgiou et al, 2006). Conclusions: Screening women under the age of 25 years cause unnecessary referral for colposcopy This may 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)
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