Characteristics and screening history of women diagnosed with cervical cancer aged 20–29 years

Abstract

Background:There was concern that failure to screen women aged 20–24 years would increase the number of cancers or advanced cancers in women aged 20–29 years. We describe the characteristics of women diagnosed with cervical cancer in England aged 20–29 years and examine the association between the period of diagnosis, screening history and FIGO stage.Methods:We used data on 1800 women diagnosed with cervical cancer between April 2007 and March 2012 at age 20–29 from the National Audit of Invasive Cervical Cancers.Results:The majority of cancers (995, or 62% of those with known stage) were stage 1A. Cancer at age 20–24 years was rare (12% of those aged 20–29 years), when compared with age 25 (24%) and age 26–29 years (63%); however, cancers in women aged 20–24 years tended to be more advanced and were more often of a rare histological type. For 59% of women under age 30, the cervical cancer was screen detected, most of them (61%) as a result of their first screening test. A three-fold increase in the number of cancers diagnosed at age 25 years was seen since the start of the study period.Conclusion:Cervical cancer at age 20–24 years is rare. Most cancers in women under age 30 years are screen detected as microinvasive cancer.

Disparities in time trends of cervical cancer mortality rates in Brazil

“…When the implementation of screening activities takes place, it is expected to first observe the impact in the older women, mainly because henceforward their access to screening is facilitated and stimulated. Furthermore, cervical cancer incidence and mortality rates are very low in young women, and their cancers can present an aggressive behavior, failing to be diagnosed under screening programs [32].…”

Benefits and harms of cervical screening from age 20 years compared with screening from age 25 years

“…This is justified because, in recent years, the majority of women screened between ages 24.5 and 27.5 years in England are screened between ages 24.75 and 25.5 years (Castanon et al , 2013). Thus, from age 27 years onwards one is comparing previously screened women regardless of whether screening starts at age 20 or 25 years.…”

Primary HPV testing: a proposal for co‐testing in initial rounds of screening to optimise sensitivity of cervical cancer screening

“…24 Most of the cancers in women aged 20-29 years were detected by cytological screening at an early stage, particularly when microinvasive (stage IA), which may partly be a result of delaying the first screening invitation to age 25. 25 Whatever the cause of the increased rates of CIN3 and cancer, primary HPV testing, as proposed in England, would be introduced in a population with a higher prevalence of disease than ever recorded before in young women: 14 273 cases of CIN3/AIS and 464 cancers were registered in women below 30 years of age in 2013. 22 • Rates of carcinoma in situ (CIN3/AIS) in 2013 at age 25-29 (the peak age band since 1992) were the highest ever recorded • Increase at age 25-29 greater than the decrease at age 20-24 A false-negative rate as low as 5% could have significant clinical consequences in this setting.…”

“…Two rounds are suggested because cytology is known to have a significant false-negative rate: CIN3, as well as screen-detected cancers, are often detected in women with previous negative cytology. 25,26 This proposal would be equally applicable to vaccinated populations, or mixtures of vaccinated and unvaccinated populations because the prevalence of abnormalities would be maintained by excluding cytological examination of samples from women with double-negative tests. Co-testing is widely used in the US from which we learn that women with double-negative co-tests are at a very low risk for disease in the future.…”