Zytologische Befunde bei Patientinnen bis zum 20. Lebensjahr in einer Dysplasiesprechstunde

Abstract

PURPOSE: The German screening program for cervical cancer starts at age 20. The goal of this study was to examine whether this is sufficient or whether screening should already be performed earlier, based on other criteria. MATERIALS AND METHODS: From 7/2004-2/2009 we evaluated the reason for referral, the age and cohabitarche of all patients younger than 20 years referred to our Dysplasia Clinic. RESULTS: 117 patients between 12-20 years (mean 18.3 years) were included. The mean age of cohabitarche was 14.9 years, 41 months prior to initial referral to our department. Twenty-four percent (28/117) were referred for vulvar condylomata. Most women (81/117; 69 %) were referred because of suspicious cervical findings. In the latter group histological examination showed LSIL (low grade squamous intraepithelial lesion) in 56 patients and HSIL (high grade squamous intraepithelial lesion) in 6 patients. Five patients received laser therapy for ectocervical CIN II, one patient had conization due to CIN III. The remaining patients (n = 19) showed no pathologic findings. CONCLUSION: These data illustrate that the first cytological pathologies appear at around three years after cohabitarche, mostly in association with LSIL. Only few patients required therapy for HSIL. The results suggest that the start of the cervical cancer screening program should depend rather on cohabitarche (for example, starting 3 years later) than solely on the patient's age. Practically, this could be accomplished by linking screening to the prescription of contraceptives. Additional monitoring in a dysplasia clinic might reduce the number of unnecessary surgical interventions.