Abnormal Paps clear usually in younger women (original) (raw)
Young Women's Cervical Cancer Risk Very Low
32 minutes ago Health - HealthDay
By E.J. Mundell
HealthDay Reporter
FRIDAY, Nov. 5 (HealthDayNews) -- Adolescent and college-age women with abnormal findings on their Pap smear shouldn't hit the panic button, a new report suggests.
In the vast majority of cases, these abnormalities simply clear up on their own, the study found.
The research may also help resolve the issue of whether colposcopy -- a more invasive, expensive follow-up test -- is always warranted in this younger age group.
"The take-home message is that the majority of women with [Pap test] abnormalities who are at or under college age don't need to rush out and get colposcopy," said Dr. Thomas C. Wright, a professor of pathology at Columbia University in New York City, and lead author of cervical cancer screening guidelines issued by the American Society of Colposcopy and Cervical Pathology.
The advent of the annual Pap smear dramatically reduced the incidence of cervical cancer in American women. Current American Cancer Society (news - web sites) guidelines recommend that adolescents and college-age women see their gynecologist for a once-a-year Pap test within three years of first sexual intercourse, or by age 21, whichever comes first.
According to Wright, a small number of women -- about 1.6 percent -- will receive a Pap test result that includes a finding of "low-grade squamous intra-epithelial lesions" (LSIL). These microscopic lesions are usually linked to the presence of a very common, potentially cancer-causing pathogen known as the human papilloma virus (HPV). About 70 percent of women will become infected with HPV at some point during their lifetime, the American Cancer Society reports.
While most of these low-grade lesions appear to be harmless, in rare cases they can progress to high-grade lesions. Doctors usually treat high-grade lesions to prevent them from turning into cancers.
In older patients with Pap smears that indicate LSIL, gynecologists often choose to examine the affected cervical tissue with an instrument called a colposcope.
But is this expensive, invasive follow-up test always necessary in young patients with LSIL test results?
In a study in the Nov. 6 issue of The Lancet, Dr. Anna-Barbara Moscicki and colleagues at the University of California, San Francisco, examined 10 years of data on the cervical health of nearly 900 patients between 13 and 22 years of age. All of the women received Pap smears once every four months during the course of the study.
About 187 of these young women received at least one LSIL test result during the study period, the researchers reported. However, 61 percent of these low-grade lesions simply disappeared on their own within a year after diagnosis, with that rate rising to 91 percent by three years post-diagnosis, according to the investigators.
The findings confirm "the benign nature of this condition in adolescent and young women," the researchers said.
In an accompanying commentary in the journal, British Drs. Anne Swarewski and Peter Sasieni said they believe the UCSF team has "clearly shown just how common and meaningless LSIL is in young women." They concluded there is "no role for colposcopy in adolescents as part of routine [gynecologic] management."
But Wright said he wouldn't go quite that far.
He agreed with the British doctors that "there is a very low rate of significant disease among adolescents, especially. What we'd classify as 'disease' here is usually nothing more than an acute viral infection that usually goes away."
On the other hand, he said, the study "isn't saying that we don't do follow-up" when young women receive a Pap test result with LSIL.
"The study authors are just saying 'wait a while' before initiating colposcopy. I do think that's the right tack -- it's not that you don't ever need to do colposcopy, it's that you don't need to do it immediately," Wright said. "First, give the lesion a chance to regress."
If the lesion persists through subsequent Pap smears, colposcopy may be warranted, even in young women, he said.
However, the new study should ease the fears of young women who receive abnormal Pap results. According to Wright, the findings offer up yet more proof that "cervical cancer or significant disease is very uncommon in this age group."