BOSTON — Don't do Pap smears in adolescents under age 21 years or in the first 3 years after their sexual debut “because it can do more harm than good.”
“High-grade lesions are rare in teenagers … and they take years to develop,” Dr. Michael S. Policar stressed at a conference on contraceptive technology sponsored by Contemporary Forums. About “91% of low-grade lesions in teens, such as cervical intraepithelial neoplasia 1 [CIN 1] often resolve spontaneously, 6% remain stable, and only 3% progress to high-grade dysplasia.” Biopsy-proven CIN 2 lesions often also regress spontaneously, he added.
Recognition of these early cytologic abnormalities on Pap testing could lead to unnecessary intervention and consequent risks, said Dr. Policar of the department of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco. As such, the American College of Obstetricians and Gynecologists recommends Pap testing should not be initiated until age 21 or 3 years after first intercourse.
Restraint is also warranted in managing teens whose Pap tests show atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions (LSIL). Consensus guidelines call for reflex human papillomavirus (HPV) testing for women with ASC-US and colposcopic examination of the cervix for HPV infection, LSIL, and high-grade squamous intraepithelial lesion (HSIL). But these no longer apply to adolescents and young women, he said, referring to the American Society for Colposcopy and Cervical Pathology guidelines for abnormal cervical screening tests (Am. J. Obstet. Gynecol. 2007; 197:346-55). Those adolescents should undergo a repeat Pap smear in 12 months.
Dr. Policar disclosed that he is a speaker for Graceway Pharmaceuticals LLC, Merck & Co., and TyRx Pharma Inc.