Does Cervical Screening in Young Women Aged 20-25 Years Lead to Unnecessary and Harmful Interventions?


Background: Cervical human papillomavirus (HPV) infection among young women (20-25 years of age) iscommon and normally transient. There are growing concerns that referral to a colposcopy clinic may lead tounnecessary treatment with an increased risk of obstetric complications. Therefore, the purpose of this studywas to determine the level of intervention for cervical abnormalities in this age group of the Northern Irelandpopulation. Materials and
Methods: A review of all serial new patients under 25 years of age, who were referredto colposcopy clinics in Northern Ireland between January 1, 2009 to June 30, 2009 formed the basis of this study.
Results: During the study period, a total of 4,767 women under 25 years of age were screened. Two-hundred-andthirty-four (4.9%) cases were referred to the colposcopy clinics. The cervical cytology results were: high-gradeabnormality in 35%, and low-grade abnormality in 31% of these cases. One-hundred-and-seventy-eight (76%)of the referred women received at least one treatment. One-hundred-and-twenty-one of 234 (51.5%) womenunderwent an excisional treatment with histology showing the presence of high-grade abnormalities (CIN2-3) in52%, CIN1 in 28%, and Koilocytosis or normal tissue in 20% of this sub-group of cases.
Conclusions: Screeningwomen under the age of 25 years cause unnecessary referral for colposcopy. This may also result in considerableanxiety and psychosexual morbidity. It leads to an over-treatment with a potential of negative impact on thefuture pregnancy outcomes (including pre-term delivery, low birth weight, and pre-term premature rupture ofmembranes).