Pap Testing and Sexual Activity Among Young Women in the United States

Saraiya, Mona; Martinez, Gladys; Glaser, Katherine; Kulasingam, Shalini

doi:10.1097/aog.0b013e3181be3db4

Cited by 17 publications

(10 citation statements)

References 20 publications

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“…Rates of guideline-consistent screening were higher among women using hormonal contraception, supporting the argument that medical visits associated with obtaining hormonal contraception are important opportunities for preventive health care, as has been previously documented (Saraiya, 2009). However, more than 10% of women who used hormonal contraception during 2006–2008 were screened for cervical cancer earlier than recommended.…”

Section: Discussionsupporting

confidence: 82%

Changes to cervical cancer prevention guidelines: Effects on screening among U.S. women ages 15–29

Henderson

Saraiya

Martinez

et al. 2013

Preventive Medicine

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Objective A shift toward later initiation of cervical cancer screening for women began in 2002. We generated national estimates of screening prevalence rates and guideline-consistent screening among U.S. women ages 15–29 before and after the first evidence-based recommendations for reduced cervical cancer screening. Method We used National Survey of Family Growth data to compare self-reported cervical cancer screening in 2002 and 2006–2008, stratified by age (15–17, 18–20, 21–29) and sexual activity. We also assessed receipt of guideline-consistent screening by selected demographic variables. Results Among females ages 15–17, the proportion screened decreased from 23% to 12%, and screening was significantly more likely to be guideline-consistent. Among females ages 18–20, 24% were screened too early in 2006–2008, but among those not yet sexually active, screening declined to 8%, appropriately reflecting new guidelines. In multivariable analysis, private health insurance, pregnancy, and hormonal contraceptive use were associated with guideline-consistent screening among sexually-active women. Conclusion Fewer adolescents were being screened before sexual initiation, representing newer guidelines. However, sexually-active young adult women also should have later screening initiation. Factors related to health care access contribute to receipt of screening. Monitoring and provider education are needed to improve guideline-consistent screening, as newer guidelines call for less screening.

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Section: Discussionsupporting

confidence: 82%

Changes to cervical cancer prevention guidelines: Effects on screening among U.S. women ages 15–29

Henderson

Saraiya

Martinez

et al. 2013

Preventive Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…Policy analyses of HPV vaccine strategies suggest that widespread HPV vaccination is more cost-effective if cervical cancer screening is initiated later or screening intervals are less frequent. 33 However, Pap testing earlier and more frequently than recommended (e.g., a screening interval of less than 3 years) was common even before the introduction of the HPV vaccine, 34–35 perhaps reflecting physicians’ disagreement or slow response to rapidly changing and conflicting guidelines, 36 women’s enthusiasm for participating in routine cancer screening, 37 or financial incentives for frequent screening. 38 Our findings may foretell patients’ desire to continue screening at pre-vaccine intervals, even if updated clinical guidelines recommend less frequent screening.…”

Section: Discussionmentioning

confidence: 99%

Knowledge and intention to participate in cervical cancer screening after the human papillomavirus vaccine

Price

Koshiol

Kobrin

et al. 2011

Vaccine

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Background If women who receive the human papillomavirus (HPV) vaccine are unduly reassured about the cancer prevention benefits of vaccination, they may choose not to participate in screening, thereby increasing their risk for cervical cancer. This study assesses adult women’s knowledge of the need to continue cervical cancer screening after HPV vaccination, describes Pap test intentions of vaccinated young adult women, and evaluates whether knowledge and intentions differ across groups at greatest risk for cervical cancer. Methods Data were from the 2008 Health Information National Trends Survey (HINTS) and the 2008 National Health Interview Survey (NHIS), which initiated data collection approximately 18 months after the first FDA approval of an HPV vaccine. We calculated associations between independent variables and the outcomes using chi-square tests. Results Of 1,586 female HINTS respondents ages 18 through 74, 95.6% knew that HPV-vaccinated women should continue to receive Pap tests. This knowledge did not vary significantly by race/ethnicity, education, income, or healthcare access. Among 1,101 female NHIS respondents ages 18 to 26 who had ever received a Pap test, the proportion (12.7%; n = 139) who reported receipt of the HPV vaccine were more likely than those not vaccinated to plan to receive a Pap test within three years (98.1% vs. 92.5%, p<0.001). Conclusions US adult women possess high knowledge and intention to participate in Pap testing after HPV vaccination. The vast majority of young adult women who received the HPV vaccine within its first two years on the market intend to participate in cervical cancer screening in the near future. Future studies are needed to examine whether those vaccinated in adolescence will become aware of, and adhere to, screening guidelines as they become eligible.

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“…A recent study estimated that potentially unnecessary cervical cytology could approach 659,000 among 5.7 million women younger than 21 years, who are not sexually active. [22] This highlights the urgent need for the education of health care providers, to stress adherence to the guidelines, in order to reduce the economic burden and potentially unnecessary cervical screening cytology in young women. Overtreatment and the relative risk on future childbearing as well as the emotional impact of labeling an adolescent with a potential precancerous lesion are also significant, as adolescence is a time of heightened concern for self-image and emerging sexuality.…”

Section: Discussionmentioning

confidence: 99%

Teenage cervical screening in a high risk American population

et al. 2011

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Background:The new 2009 ACOG guideline for cervical cytology screening changed the starting age to 21 years regardless of the age of onset of sexual intercourse. However, many recent studies have shown a dramatic increase in the incidence of cervical epithelial abnormalities among adolescents within the past two decades.Materials and Methods:For this study, the reports of 156,342 cervical cytology were available of which 12,226 (7.8%) were from teenagers. A total of 192 teenagers with high grade intraepithelial lesion (HSIL) cervical cytology were identified. The ages ranged from 13 to 19 years with a mean of 17.7 years and a median of 18 years. Among them, 31.3% were pregnant, 12.0% were postpartum, and 13.5% were on oral contraceptive. Ninety-eight had prior cervical cytology.Results:The teenagers had statistically significant higher detection rates of overall abnormal cervical cytology (23.6% vs. 6.6%, P = 0), with 15.4% vs. 3.2% (P = 0) of low grade intraepithelial lesion (LSIL) and 1.8% vs. 1.0% (P = 2.56 × 10-13 ) of HSIL compared to women ≥20 years. The teenage group had the highest abnormal cytology among all age groups. The LSIL/HSIL ratio was 8.5:1 for teenagers and 3.1:1 for women ≥20 years. A total of 131 teenagers had cervical biopsies within 12 months of the HSIL cytology, with diagnoses of 39 CIN 3, 1 VAIN 3, 15 CIN 2, 62 CIN 1, and 14 had a negative histology (CIN 0). Only in 19 of these 39 women, the CIN 2/3 lesion proved to be persistent.Conclusion:We conclude that cytology screening of high risk teenagers is effective in detecting CIN 2/3 lesions. Moreover, treatment and careful follow-up can be realized.

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Pap Testing and Sexual Activity Among Young Women in the United States

Abstract: III.

Cited by 17 publications

References 20 publications

Changes to cervical cancer prevention guidelines: Effects on screening among U.S. women ages 15–29

Changes to cervical cancer prevention guidelines: Effects on screening among U.S. women ages 15–29

Knowledge and intention to participate in cervical cancer screening after the human papillomavirus vaccine

Teenage cervical screening in a high risk American population

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