Pap abnormalities in adolescents require cautious management

Adolescents with abnormal cervical cytology screening results should be treated less aggressively than adult women, the American College of Obstetricians and Gynecologists (ACOG) recommends.

ACOG issued its committee opinion on evaluating and treating abnormal cervical cytology in adolescents, in the April issue of Obstetrics & Gynecology. In many cases, the authors write, monitoring is more appropriate than more invasive treatment, given that cervical intraepithelial neoplasia (CIN) grades 1 and 2 typically regress in adolescents, and that “surgical excision or destruction of cervical tissue in a nulliparous adolescent may be detrimental to future fertility and cervical competency.”Although treatment for atypical squamous cells of undetermined significance with high-risk human papillomavirus warrants immediate colposcopy in adult women, according to ACOG, the college recommends a repeat Pap at six and 12 months or a high-risk HPV test only, for adolescents. If test results remain abnormal, colposcopy should be performed. For low-grade squamous epithelial lesions in adolescents, ACOG also recommends a repeat Pap test at six and 12 months or a high-risk HPV test at 12 months rather than immediate colposcopy. And for CIN 2, the committee recommends close follow-up at four to six month intervals with cytology or colposcopy, while noting that follow-up without treatment is not recommended for noncompliant patients.All other recommendations for adolescents are the same as for adult women.ACOG also recommends that cervical cancer screening be initiated in adolescents three years after sexual activity begins, but before age 21, while a patient’s risk of future non-compliance and of contracting HPV infection should also be considered. “Obtaining a complete and accurate sexual history, therefore, is critical,” the committee, states.They add that clinicians also should consider issues of confidentiality and parental consent when colposcopy or other more invasive treatment is required for adolescents.(Source: Obstet & Gynecol 2006;107:963-968: Reuters Health: Oncolink: April 2006.)