Cervical screening in 20–24-year olds

Rieck, Gudrun; Tristram, Amanda; Hauke, Anne Hildegard; Fielder, H.; Fiander, Alison

doi:10.1258/096914106777589551

Cited by 17 publications

(18 citation statements)

References 47 publications

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“…[644][645][646][647][648][649][650][651] Our search for new and pertinent studies identified four cohort studies relating to cervical cytology screening. [652][653][654][655] A related study 640 provided historical time trend mortality data related to cervical cancer screening programs. Finally, we identified one additional study reporting on the adverse events from human papillomavirus (HPV) vaccination in Australia 656 and one meta-analysis reporting adverse pregnancy outcomes associated with treatment of cervical dysplasia.…”

Section: Resultsmentioning

confidence: 99%

“…644,645 The screening programs used invitation and reminder letters and practitioner incentives to increase screening rates from 61% to 83% of the population. Data from Rieck and coworkers 654 showed a reduction in cervical cancer (relative risk 0.48, 95% CI 0.23-0.98) (Table 21B). Adverse effects resulting from referral for colposcopy include anxiety about pain and discomfort.…”

mentioning

confidence: 91%

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Evidence-based clinical guidelines for immigrants and refugees

Pottie¹,

Greenaway²,

Feightner³

et al. 2010

Canadian Medical Association Journal

397

333

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 91%

Evidence-based clinical guidelines for immigrants and refugees

Pottie¹,

Greenaway²,

Feightner³

et al. 2010

Canadian Medical Association Journal

397

333

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“…While some studies in developed countries recommend screening from age 20, others have confirmed cervical screening in women aged 20-34 is less effective than in older women (Rieck et al, 2006;Sasieni et al, 2009). Controversy is founded mainly on the anxiety of an abnormal test, unnecessary treatment to low grade lesions that might regress spontaneously, and on reports that have associated preterm delivery on pregnancies after treatment of lesions (Kyrgiou et al, 2006).…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Cervical Cancer Screening Amongst Women of Reproductive Age from Yucatan, Mexico

Conde-Ferráez

Allen²,

Martinez³

et al. 2012

Asian Pacific Journal of Cancer Prevention

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This study aimed to analyse the participation of women of reproductive age in a cancer screening program, and survey reasons for non-screening in a region from Mexico with high cervical cancer mortality. A total of 281 obstetric patients from a previous HPV study in a social security hospital during 2008-2009 were included. Reasons for not participating in the screening were directly asked. HPV positive patients were invited to participate in an informative workshop, and they filled in a knowledge questionnaire. The women ranged in age from 14-47 years; 123 (43.8%) had never participated in screening, of which 97 (78.9%) had their first sexual intercourse 2 to 10 years ago, resulting in 25% HPV positive. Screening history was strongly associated with 2 or more gestations (OR= 10.07, p=0.00) and older age (OR=6.69 p=0.00). When 197 women were contacted and interviewed, reasons referred for non-screening were ignorance, lack of interest or time, recent sexual onset, shame and fear. More than 50% of the workshop participants showed knowledge of HPV, while 38.9% and 25% knew about Pap smear and cervical cancer. A high percentage of women of reproductive age have never had a Pap smear. Promoting the screening program in medical facilities seems to be important in this population. New approaches to inform vulnerable individuals on the benefits of screening need to be implemented, especially for young women.

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“…This should be compared with a coverage rate of around 50% in the same age group. 1 These data show that women with cancer diagnosed at ages 20-24 are far more likely to have been screened than the general population (PE0.002). Indeed the data are interpretable only if a proportion of the eight screen-detected cancers would not have been diagnosed until age 25 (or older) in the absence of screening.…”

Section: Cases From Walesmentioning

confidence: 87%

Cervical screening in 20–24-year olds

Sasieni

Kitchener

Patnick³

et al. 2006

J Med Screen

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The paper by Rieck et al.1 on pages 64-71 of this issue of the Journal of Medical Screening provides the justification for continuing to invite women aged 20-24 for cervical cancer screening in Wales. The decision to screen always involves a balance between harms (including costs) and benefits, and we believe that the benefits should clearly outweigh the harms since those harmed are not necessarily the same as those who benefit from screening. With regard to cervical screening in women aged 20-24 years, we still feel that the evidence of the benefits outweighing the harms is too weak to recommend population screening.Rieck and colleagues start by reviewing the literature relating to cervical screening in women aged 20-24, with particular emphasis on the natural history of high-grade cervical lesions, and then consider the effect of screening in young women on incidence, mortality and screeninginduced morbidity. Most of the literature reviewed was published prior to the recommendation of the Advisory Committee on Cervical Screening to the Minister in 2003 and virtually all of the remainder was available to the Committee at that time. With the exception of the data from Wales collated for the first time in the Rieck et al. paper, the decision to recommend cessation of screening in women aged 20-24 was therefore based on the same evidence as that considered by Rieck and colleagues. How have the two groups come to opposite conclusions? NATURAL HISTORY OF CIN3We agreed that the available evidence suggested that between 25 and 50% of CIN3 would eventually progress to invasive cancer if not treated. We also reasoned that very little of the CIN3 detected in women aged 20-24 would progress to cervical cancer by age 25 (or even age 28). Thus a certain proportion of CIN3 detected under age 25 would regress by that age, while almost all the rest could be screendetected at age 25. Even if missed at that age (due to the imperfect sensitivity of the smear test), the lesion would still have a good chance of being detected (still as CIN3) at age 28. We have no evidence that it is better to detect CIN3 at age 22 than to detect the same lesion at age 25. By delaying the screening until age 25, women with regressive disease will avoid unnecessary treatment and anxiety, particularly for low-grade disease. EFFECTIVENESS OF CERVICAL SCREENING IN YOUNG WOMENThe research that strongly influenced the Advisory Committee's recommendation was the UK audit of cervical screening, which found a significant interaction between age and the effect of screening on the incidence of stage 1B or worse cervical cancer.2 Data from the UK screening programmes showed a much more limited effect of screening on the incidence of cervical cancer in young women than in older women.We are also aware of the various studies that have attempted to estimate the effect of screening in the UK by modelling trends in cervical cancer incidence and mortality. The earlier work of one of us (PS) suggested that the effect of screening both on incidence and mortality was gr...

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Cervical screening in 20–24-year olds

Cited by 17 publications

References 47 publications

Evidence-based clinical guidelines for immigrants and refugees

Evidence-based clinical guidelines for immigrants and refugees

Factors Associated with Cervical Cancer Screening Amongst Women of Reproductive Age from Yucatan, Mexico

Cervical screening in 20–24-year olds

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