Age Of Cervical Screening Research Articles

The age of cervical screening should be reduced: FOR: Invite them all by 25; use clinical judgement rather than refusing them below that age.

Should the lower age limit of 25 for cervical screening be reduced? Or is it too late, now that 80% of women aged 20–24 will have been vaccinated by 2016? My answers to these questions are, respectively, yes and no. CIN3 and the less frequent CGIN are the lesions at greatest risk of progression to invasion. CIN3 spreads laterally and into crypts before invasion develops (Tidbury et al. BJOG 1992;99:853–6) at a rate estimated as ~1% per year. The risk of preterm delivery is related to depth of excision (Castanon et al. 2014;349:g6223). Small lesions are more likely to be treated adequately by a <10-mm-deep LLETZ (with no significant risk) than are larger lesions left untreated for several years. In 2003, 4000 cases of CIN3 (20% of all cases) were detected at age 20–24 and registrations in that age band were increasing. Increases in the same birth cohorts 5 years later (age 25–29) suggest a higher risk of disease in women born since about 1975 (Herbert et al. reply to Castanon et al. Br J Cancer 2013; 109:35–41). Recent figures do not suggest regression of untreated CIN3 in women aged 20–24; rather they suggest rates of progression greater than estimated because registrations of cancer below 30 years of age have increased proportionately more than CIN3 (100% compared with 50%). The downside of screening women aged 20–24 is the potential unnecessary treatment of CIN2: although progression to CIN3 takes place in 20–25%, around half regress spontaneously (Holowaty et al. 1999. J Natl Cancer Inst 91:252–8; Castle et al. Obstet Gynecol 2009; 113:18–25). Protocols for selective treatment of CIN2 could be implemented, equally relevant at age 25–29, which is the peak age band for CIN3. Uptake of young women for cervical screening has fallen during the last decade and less than two-thirds of women aged 25-29 are now screened (http://www.hscic.gov.uk/catalogue/PUB15968/cerv-scre-prog-eng-2013-14-rep.pdf). Abandoning the conflicting message that screening is harmful below 25 but essential above that age might help reverse this trend. There is little excuse for cancer developing in a young woman, who may have been sexually active since before the age of consent and who has been refused screening in an overly restrictive programme. Doctors should be allowed to use their clinical judgement when carrying out cervical cytology tests in women below 25 years of age – by which age all women should at least have been invited. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

The age of cervical screening should be reduced

The age of cervical screening should be reduced

PWE-052 Low uptake of cervical screening in immunosuppressed patients with inflammatory bowel disease at a district general hospital

Introduction ECCO guidelines strongly recommend regular cervical screening for women with inflammatory bowel disease (IBD), especially if treated with immunomodulators. We wanted to investigate if our immunosuppressed female IBD patients were being screened in accordance with the NHS Cervical Screening Programme (CSP) and identify if they were at increased risk of cytological abnormalities. Method We searched our database for patients commenced on azathioprine, mercaptopurine, methotrexate, infliximab or adalimumab from June 2005 to October 2013. We excluded patients who were on these drugs for less than one year, were not of cervical screening age (25–64) or had had a hysterectomy. Information provided from general practitioners, local cytology department and Open Exeter (CSP database) were used to identify women participating in CSP and if they showed any abnormalities. Results 153 patients met the criteria to participate in the CSP. 115 (75%) were up-to-date compared to a national participation rate of 78.3%. 25 (16%) had participated in the CSP but were not up-to-date at the time of report. 9 (6%) had not participated in the CSP and 4 (3%) actively declined participation. Date from the 2013 National CSP demonstrates that 5.3% of those screened displayed low grade abnormalities and 1.2% had high grade abnormalities. Of our 153 patients 13 (8.5%) had cytological abnormalities. 5 (3%) patients had abnormalities before immunosuppressive therapy with 1 (0.7%) patient showing high grade abnormality (moderate dyskaryosis with CIN1 confirmed) which subsequently remained negative whilst on immunosuppression. Our results identified 7 (4.6%) patients with low grade abnormal cytology results after commencing immunomodulators (3; borderline nuclear changes in squamous cells, 2; mild dyskaryosis, 2; low grade dyskaryosis and high risk HPV detected). Only 1 (0.7%) patient had high grade dyskaryosis during immunosuppression but their follow up cytology was negative. Conclusion IBD patients are at increased risk of cytology abnormalities which is concerning since our CSP participation is below the national average. However data from our unit suggests that commencing immunosuppression therapy did not increase that risk any further. This data underlines that IBD specialists need to educate and encourage patients to participate in the CSP programme. Disclosure of interest K. Wade Conflict with: Abbvie sponsorship to attend ECCO, H. Johnson: None Declared, H. Dewhurst: None Declared, S. Weaver Conflict with: been on advisory board for MSD and Abbvie but not for past 12 months, S. McLaughlin Conflict with: Abbvie sponsorship to attend DDW, Abbvie Advisory board, Ferring sponsorship to attend ECCO.

A retrospective study of cervical screening in women under 25 years (2005–2009)

Since 2003, when the age threshold of cervical screening in England has been raised from 20 to 25, there have been many calls to restore the previous starting age for cervical screening as there are concerns about the delaying of initiating cervical screening may result in an increase in the risk of cervical cancer. We conducted a retrospective study to analyse the safety of changing the starting age of cervical screening programme in England to the age of 25, by reviewing the cervical cytology performed in 426 women under 25 years in Bromley Borough of London, UK, between 2005 and 2009. We conducted a retrospective analysis of 426 women under 25 years, who were referred with cervical smears taken at Bromley PCT's to the colposcopy clinic at Bromley Hospitals, South London Healthcare NHS Trust, over a 4-year period, between 2005 and 2009. The colposcopy findings and histology results were reviewed and analysed. In our review, 44.80 % of smears showed mild dyskaryosis. 23 and 12 % showed moderate dyskaryosis and severe dyskaryosis, respectively. 11.2 % had borderline smear, and 0.2 % revealed glandular changes. On colposcopic examination, only 16.2 % (69) were reported as normal; however, 25.8, 20 % of the women were diagnosed with low and high grade abnormalities, respectively. 12 % (53) of the cases showed HPV-related changes, whereas no suspected malignancy was found. Colposcopic-directed cervical biopsy was obtained in 228 women (~54 %) depending on the colposcopic examination findings. The most histological finding was CIN I which constitutes 48 % (110) of all biopsies. However, 25 % (58) and 9 % (20) revealed CIN II and CIN III, respectively. The glandular changes noticed in only one case (0.44 %). The treatment was planned for 130 women, a significant proportion (30.5 %) of the 426 women who referred for colposcopy. The histological examination of the biopsies showed CIN in 91 % of the cases (115), 74.8 % (86) of them had CIN II (36) or CIN III (50). In addition, the glandular changes found in two cases (1.6 %). More importantly, there was one case diagnosed with micro-invasive cervical cancer (0.79 %) and this comprises 0.23 % of our sample. In view of the size and the heterogeneity of our sample, it is difficult to recommend changing the starting age of the cervical screening programme. However, we strongly recommend to have a low threshold to offering cervical cytology to the women under 25 on clinical basis, particularly, after the recent introduction of HPV triage (outside the scope of this study), which will enable us to avoid the two main disadvantages of the early screening, namely over-diagnosis and over-treatment.

Student lobbying to screen women at 20.

A nursing student diagnosed with cervical cancer when she was 20 is campaigning to get the age of cervical screening lowered from 25 to 20.

Opinions split on minimum age for cervical smears.

Nurse opinion is divided over a decision to keep the minimum cervical screening age of women at 25 in England.