Cervical Cancer Screening of Adolescents and Young Women: Further Evidence Shows a Lack of Clinical Value

Abstract

Study objective: To assess the prevalence of cytological abnormalities among young people from a large population in the city of São Paulo (Brazil).

Design: Retrospective, observational analysis of data from the institution's data processing center.

Setting: A private laboratory in São Paulo (Brazil).

Participants: Comparison of 3 different groups (ie, adolescent women [aged ≤19 years], young adult women [aged between 20 and 24 years], and adult women [aged 25 years and older]).

Interventions: Assessment of results from all cervical-vaginal smears collected for cytology between January 2010 and December 2015.

Main outcome measures: Comparative analysis of cytological abnormalities in the 3 different groups.

Results: A total of 1,026,671 satisfactory cytology tests were performed. The proportion of cytological abnormalities was found to decrease with age (P < .001) and was similar in the groups comprised of adolescents and young adults, with 3.405/ 20.921 (16.3%) and 13,635/ 78,277 (17.4%), respectively, and 74,320/ 927,473 (8.0%) in the group of adult patients (P < .001). Among the positive cytologies in the group of adolescents, 3,331/ 3,405 (97.8%) represented low-grade lesions and 74/ 3,405 (2.2%) high-grade lesions, whereas among adults older than 25 years old, these figures were 69,092/ 74.320 (93%) and 5,228/ 74.320 (6.9%), respectively. No cases of cancer were found in the group of adolescents.

Conclusion: Cytological screening of young people is not recommended because of the low prevalence of high-grade cytological abnormalities in this population, with cancer being a rare event. This inadvertent screening could lead to unnecessary complementary exams and overtreatment, which could compromise the reproductive future of these young women.

Keywords: Adolescent; Cervical intraepithelial neoplasia; Cytological techniques; Early detection of cancer; Uterine cervical neoplasms; Young adult.