Should Cervical Cancer Screening be Performed Before the Age of 25 Years?

Moscicki, Anna‐Barbara; Perkins, Rebecca B.; Saville, Marion; Brotherton, Julia

doi:10.1097/lgt.0000000000000434

Cited by 4 publications

(8 citation statements)

References 26 publications

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“…One reason for this proposal is that cervical cancer is more prevalent among women aged 25_29 in the USA. Screening women younger than 25 would reduce the risk of cervical cancer in women aged 25_29 (25). A further reason is the lack of national cancer screening programmes to screen and detect cervical pre-cancer lesions among young women (25).…”

Section: Discussionmentioning

confidence: 99%

“…Screening women younger than 25 would reduce the risk of cervical cancer in women aged 25_29 (25). A further reason is the lack of national cancer screening programmes to screen and detect cervical pre-cancer lesions among young women (25). The countries in our study do not have large scale comprehensive national screening programmes that reach a diverse group of women at risk of cervical cancer (4,11).…”

Section: Discussionmentioning

confidence: 99%

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Impact of the 2013 WHO guidelines for screening and treatment of cervical precancerous lesions on women’s screening rates, by HIV-status, in East and Southern Africa: A regression discontinuity design analysis

Chipanta,

Osborne,

Bohlius

et al. 2024

Preprint

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Introduction: In 2013, the World Health Organization (WHO) issued guidelines for cervical pre-cancer screening. It recommended screening women aged 30-49, and younger women once they tested HIV-positive. Subsequent WHO guidelines recommended screening women living with HIV (WLHIV) starting at age 25. However, the impact of 2013 guidelines and age to start screening on screening has not been studied. Methods: We used a regression discontinuity design (RDD) analysis of population-based data to assess the impact of the 2013 WHO guidelines on the screening rates for women according to HIV status and age group in Ethiopia, Malawi, Rwanda, Tanzania, Zambia, and Zimbabwe. The outcome was self-reported ever having been screened for cervical pre-cancer between 2008 and 2018. We compared the screening rates according to HIV status and age group, before and after age 25 years. And before and after 2014, the year countries adopted the 2013 guidelines. We then used a data-driven optimal bandwidth selection procedure to estimate the guidelines average treatment effect (ATE), with a local polynomial regression discontinuity and robust bias-corrected confidence intervals. We validated the RDD methodology overall and for women with a significant ATE at the country-level analysis. Results: We included 73179 women: 6680 (9.1%) living with HIV, 4328 (5.9%) with unknown HIV status, and 62171 (85.0) with a negative HIV status. 5726 (7.9%) reported having ever been screened; 4022 (6.5%) with unknown HIV status, 525 (12.1%) with a negative HIV status and 1179 (17.7%) living with HIV. Adolescent girls and young women living with HIV (AGYWLHIV) aged 15-24 reported screening less often (917 (13.7%)) than their peers with unknown (1677 (38.8%)) or positive HIV status (27278 (43.9%)) (P<0.001), or older women. The ATE of screening was 0 for women with unknown or positive HIV status, for whom the RDD was valid. Conclusion: We found no evidence the 2013 WHO guidelines increased or reduced womens cervical pre-cancer screening. However, AGYWLHIV reported screening less often. Policy makers should lower the age to start screening WLHIV from 25 to 15 to screen more AGYWLHIV. Studies are required to examine the impact of the guidelines on cervical pre-cancer screening in more countries.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of the 2013 WHO guidelines for screening and treatment of cervical precancerous lesions on women’s screening rates, by HIV-status, in East and Southern Africa: A regression discontinuity design analysis

Chipanta,

Osborne,

Bohlius

et al. 2024

Preprint

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“…We believe that promoting an effective cervical cancer screening with primary HPV in younger age groups of women, including women below 25, may be associated with building appropriate habits, which may result in a positive change in recently recorded increases in cancers rate among women 25-29 years. This may be particularly important in countries with very high HDI and with still too low HPV vaccination coverage and may be a factor making it independent of changes in sexual behavior [3]. Furthermore, primary HPV screening in young women might be a part of the catch-up vaccination strategy [27].…”

Section: Discussionmentioning

confidence: 99%

“…In countries with a very high HDI, there has been an increase in cervical cancer incidence in recent years, and this applies to women in the 20-39 age group [2], which is a worrying phenomenon. The onset of cancer rates growth is observed in the range of 25-29 years, which should draw the attention of prevention systems to women under 25 years of age and their effective screening for the precancers detection [2,3]. Vaccination against HPV, together with secondary prevention, are the important factors in reducing cervical intraepithelial lesions in young women [4,5].…”

Section: Introductionmentioning

confidence: 99%

Is Primary HPV with Secondary p16/Ki67 Dual-Stain an Alternative HSIL-Risk Detection Strategy in Cervical Cancer Screening for Women under 30 Years?

et al. 2021

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Recently, cervical cancer rates elevation has been noted in women aged 20–39 years in regions with a very high human development index (HDI). The onset of cancer elevation rates is observed in the age range of 25–29 years, which should necessitate effective precancer screening in younger age groups, including those <25 years. From 30.066 liquid-based screening tests results (n = 30.066), 3849 liquid-based cytology, 1321 high-risk human papillomavirus (HRHPV) and 316 p16/Ki67 performed in women <30 years were selected. Performance characteristics were calculated for three screening models: primary HRHPV with p16/Ki67 triage, primary cytology with reflex HPV and primary cytology alone. Primary HRHPV with p16/Ki67 triage was significantly more sensitive in high-grade squamous intraepithelial lesion quantified with cervical intraepithelial neoplasia grade 2 or worse [HSIL(CIN2+)] detection than cytology with reflex HRHPV and cytology alone (83.3% vs. 70.8%/45.8%) and had significantly higher diagnostic predictive values (PPV:29.4%/21.3%/22.9%; NPV:91.7%/82.9%/82.2%, respectively at CIN2+ threshold). The number of colposcopies per HSIL(CIN2+) detection indices was 3.4, 4.7 and 4.4, respectively. Primary HPV testing in women <30 years with p16/Ki67 triage of HPV-positive cases might be an effective cervical cancer screening strategy for HSIL(CIN2+) detection with superior diagnostic performance when compared with primary cytology-based models. Women <25 years might also benefit from an introduction to a more sensitive screening approach.

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“…Screening was required every three years, until the age of 50 where it extended to every five years, until the programme was updated in 2012, inviting women from the age of 24.5 to ensure all women were screened by the age of 25 (Chrysostomou et al, 2018, Castanon, Tataru and. This increase in age caused a public concern, with cervical cancer rates rising in women aged 20-24 years, there were allegations that younger women were overlooked, creating inequity in care which went against the ethos of the public health strategy for cervical screening (PHE, 2019a, Moscicki et al, 2018. Despite this, the policy remains unchanged with studies confirming that screening earlier can cause more harm than good by over-diagnosis and over-treatment (Castanon and Sasieni, 2018).…”

Section: Cervical Screeningmentioning

confidence: 99%

Meeting the challenges of cervical cancer screening and HPV vaccination in the UK

Westwood

Lavery

2021

Primary Health Care

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Should Cervical Cancer Screening be Performed Before the Age of 25 Years?

Cited by 4 publications

References 26 publications

Impact of the 2013 WHO guidelines for screening and treatment of cervical precancerous lesions on women’s screening rates, by HIV-status, in East and Southern Africa: A regression discontinuity design analysis

Impact of the 2013 WHO guidelines for screening and treatment of cervical precancerous lesions on women’s screening rates, by HIV-status, in East and Southern Africa: A regression discontinuity design analysis

Is Primary HPV with Secondary p16/Ki67 Dual-Stain an Alternative HSIL-Risk Detection Strategy in Cervical Cancer Screening for Women under 30 Years?

Meeting the challenges of cervical cancer screening and HPV vaccination in the UK

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