In Portugal, cervix cancer has an overall incidence of 13.5 in 100000 women, having its peak incidence in the 4th decade of life. The mortality rate decreased due to an organized screening program, comprising women between 25 and 65 years of age. Organized screening in women under 25 years has not demonstrated any reduction of the incidence or mortality rates. Nonetheless, these women are still screened, occasionally. Based on this fact as well as on the increased occurrence of false-positive screenings in women under 21, it is perfectly adequate that cytological changes or HPV tests are not highly valued. Similarly, between the ages 21 to 25, the follow up of these changes should globally be less invasive, adopting a wait-and-see attitude.
The purpose of this study is to compare the risk factors for cervical cancer between women under 25 and the remaining sample. In this age group, we intend to evaluate colposcopy findings, treatment and follow up.
Retrospective study of women referred to the Cervical Pathology practice in our Department in 2014, through review of their clinical files (n=356). Statistical analysis made through STATA® v.13.1.
Of the total sample, 5.6% (n=20) of women were younger than 25 years. These presented a statistically significant greater number of partners and an earlier start of their sexual activity when compared to the remaining sample. The most common cytological alteration was low squamous intraepithelial lesion (LSIL) (65%). Upon the first appointment, 30% had a cytology done and 90% a colposcopy, 22.2% of which were normal. Of the 77.8% that had cytological alterations, 78.6% were subjected to a biopsy. Regarding the patients referenced for an LSIL injury, of whatever extent, 100% of the colposcopies found minor anomalies, whereas of those that underwent a biopsy 100% of the histology revealed minor injuries. The most serious injury detected was cervical intraepithelial neoplasia grade 2 (5.5%).
The alterations resulting from the occasional screening in women under 25-years of age continue to account for an increased number of medical appointments. Moreover, these patients present increased risk factors when compared to older patients with cervical pathology. Colposcopy proved to be the favoured exam for the initial approach, with a high number of biopsies. A high concordance between cytology, colposcopy and histological findings was verified, which strongly supports that a less invasive attitude may be adopted. Scheduling appointments with a greater time interval might also be a strategy to avoid over-treatment.
Moutinho JA. Consenso sobre infecção por HPV e neoplasia intraepitelial do colo e vagina, SPG, 2014; Lees B. Cervical cancer screening: evidence behind the guidelines, AJOG, April 2016; Sasiensi P. Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data, BMJ, 2009; Moscicki A. Management of Adolescentes with abdnormal cytology and histology for OBGYN Clinics of North America, NIH Public Access, 2008.