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Exceptions to Pap Screening in Adolescents

July 21, 2010

Washington, DC -- Most adolescent girls should wait until they turn 21 to have their first Pap test, but those who have HIV and others with weakened immune systems should begin routine cervical cancer screening right away, according to The American College of Obstetricians and Gynecologists. The College's recommendations on screening and managing cervical cancer in adolescents, published in the August issue of Obstetrics & Gynecology, address the exceptions to Pap screening before age 21 as well as the handling of abnormal test results. The College continues to advise against human papillomavirus (HPV) testing in adolescents.

Healthy immune systems typically eliminate HPV, the virus that causes cervical cancer, from the body. People with weakened immune systems, however, cannot fend off viral infections as easily or at all. Because of their weakened immunity, HIV-infected adolescent girls should have cervical screening twice in the first year after their HIV diagnosis and once a year thereafter. Sexually active adolescents who have weakened immune systems from an organ transplant or because of long-term steroid therapy also should be screened six months apart in the first year after they begin having sex and then continue with annual Pap tests.

"The vast majority of adolescent girls should wait until they turn 21 before they have their first Pap test," said Cheryl B. Iglesia, MD, chair of the Committee on Gynecologic Practice. "Our guidelines now specify the exceptions to this recommendation." Dr. Iglesia emphasized that even though most teen girls no longer need Pap screening, they need to continue with annual visits to their gynecologist.

Any adolescents who had one or more Pap tests with normal results before the guidelines changed in December 2009 should not be screened again until they reach age 21, according to The College. Likewise, teens who have had a previous abnormal Pap test followed by two normal test results also should wait until age 21 to be rescreened.

The College does not recommend HPV testing for adolescents. "There's no point in testing for HPV because it's so common among teens and 90% of HPV infections are naturally resolved by the immune system within two years," said Dr. Iglesia. "Adolescents have been over-treated for something that typically resolves on its own. We know that unnecessary treatments compromise the cervix and increase a teen's risk of having a preterm birth later in life."

Adolescents who have low- to high-grade precancerous lesions (dysplasia)—with the exception of cervical intraepithelial neoplasia 3 (CIN 3)—generally should be managed by periodic observation. The guidelines say that rescreening can be delayed until age 21 when the Pap test results show regression of the dysplasia, but annual screening also is an acceptable alternative. Although very rare in adolescents, CIN 3 is considered a significant precancerous condition that does require treatment with cryotherapy, laser therapy, or loop electrosurgical excision.

Committee Opinion #463, "Cervical Cancer in Adolescents: Screening, Evaluation, and Management," is published in the August 2010 issue of Obstetrics & Gynecology.

The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation's leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 55,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women's health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org


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