Potential effects of age-based changes in screening guidelines on the identification of women at risk for developing cervical cancer.

ABSTRACT

Current American Cancer Society (ACS) guidelines estimated that screening starting at the age of 25 years with Pap and/or human papillomavirus (HPV) testing is sufficient to prevent cervical cancer (CC). The effect of having HPV infections without Pap-based care until age 25 on the prevalence of higher grades of cervical intraepithelial neoplasia (≥ CIN 2) and their determinants are largely unknown. The objectives of the study were to document the potential effects of age-based changes in screening guidelines on the identification of ≥ CIN 2 and their determinants. The study included 1584 women diagnosed with abnormal Pap and tested for HPVs and histological diagnoses of cervical lesions. The association between demographic/lifestyle factors and HPV status and risk of being diagnosed with ≥ CIN 2 among younger (21-<25 years) or older (≥ 25 year) women was tested using unconditional multiple logistic regression models. We observed that younger women who are not screened have a similar or higher risk of developing specific high risk (HR)-HPV genotype-associated ≥ CIN 2 lesions compared to older women who are screened according to the current guidelines. In addition, younger women who reported live births, smoking, contraceptive use and a higher number of sexual partners were significantly at higher risk of being diagnosed with ≥ CIN 2. Targeted screening of younger women at risk for developing ≥ CIN 2 will address the concern of overtreatment while providing the recommended care to those who require such care to prevent the development of CC.