New strategies for cervical cancer screening in adolescents

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Abstract
This paper reviews the epidemiology and natural history of human papillomavirus (HPV) infection in young women, the development of new technologies for cervical cytology screening, proper cervical cytology sampling technique, the new Bethesda system for reporting cervical cytology findings, and several recent professional society guidelines for cervical cytology screening and management of cytologic abnormalities in adolescents. Natural history studies of HPV infection in healthy young women show that infection is quite prevalent, but is generally transient. New and sensitive technologies such as HPV DNA testing and liquid-based cytology are more likely to detect cytologic abnormalities in young women who are at low risk for actual invasive cervical disease. This sensitivity potentially places adolescents at risk for increased anxiety, testing, and intervention. The multi-center ASCUS-LSIL Triage Study has shown that HPV DNA testing can be used safely to minimize intervention in many cases. HPV infection is common in young women, but rarely progresses to invasive cervical disease. Providers need to inform themselves about new professional society guidelines that suggest delaying initiation of cervical cancer screening to within 3 years of onset of sexual activity. Given the idiosyncrasies of this population, the authors counsel using clinical discretion when applying these guidelines to individual teenagers. In light of the extremely low likelihood of invasive disease in this age group, providers must separate the provision of contraceptive services and sexually transmitted disease screening from requirements for cervical cancer screening.