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Sept. 30, 2004 — The American College of Obstetricians and Gynecologists
(ACOG) today issued a committee opinion to help clear up confusion over when
adolescent girls should receive their first Pap test vs. when they should have
their first gynecologic visit.
Because of recent changes in cervical
cancer screening guidelines that have pushed the baseline Pap test back three
years, there is concern that teens will delay important preventive care and STD
testing until they come in for their first Pap screening, conceivably as late as
age 21. The new opinion also stresses the need to avoid overtreatment of
abnormal cervical cytology in adolescents.
Previous cervical cancer
screening recommendations advised an initial Pap screen shortly after first
intercourse or by age 18, whichever occurred first. New guidelines recommend
that a baseline Pap be performed approximately three years after intercourse or
by age 21, whichever occurs first. The concern is that many adolescents will
receive less health care if they interpret the new recommendations as indicating
that they can delay their first ob-gyn visit until they turn 21. The opinion
points out that teens and their parents may not realize that there is a
difference between a Pap test and a routine annual exam.
"It's very
important that parents and adolescents understand that just because new
guidelines say that you can wait about three years after having first
intercourse to have your first Pap, doesn't mean you should wait until that time
to make your first visit to an ob-gyn," says S. Paige Hertweck, M.D., immediate
past chair of ACOG's Committee on Adolescent Health Care. "The earlier we can
see young women, the better chance we have of providing preventive care,
screening for other STDs, and guiding them to make healthy behavioral
choices."
ACOG strongly recommends that an adolescent girl's first visit
to an ob-gyn for health guidance, screening, and preventive health occur between
ages 13 and 15, ideally before sexual activity has occurred. Data show that over
60 percent of adolescent girls have had intercourse by age 18, which puts them
at risk of acquiring STDs, including human papillomavirus (HPV), the virus that
can cause cervical cancer. Both parents and adolescents need to understand that
an adolescent's initial visit does not necessarily include a pelvic examination
or a Pap test. Annual visits, whether they include a Pap or not, are strongly
recommended.
"We need to consider more than just age at first intercourse
when considering Pap screening,” says Dr. Hertweck.”Certain behaviors, including
having a history of other STDs or having multiple sexual partners, put girls at
a higher risk of HPV infection or cervical intraepithelial neoplasia (a
noncancerous condition that, if severe, can develop into cancer if left
untreated), or both."
ACOG points out that adolescents may be more
susceptible than adults to HPV infection due to biologic or physical factors.
They also have a higher prevalence of abnormal Pap test results compared with
adult women, but the severity of their cervical lesions is generally
lower.
According to ACOG, adolescents with abnormal Pap screen results
should be counseled and monitored closely to avoid aggressive treatment of
benign lesions because most lesions regress on their own without treatment and
do not result in cervical cancer. More importantly, surgical excision or
destruction of cervical tissue in the adolescent female may affect future
fertility.
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