Women's Health/Children's Health

Cervical cancer rates among younger women decreased over the past 25 years

The rate of cervical cancer detected among women less than 20 years of age over many decades of screening in the United States has not changed significantly, according to a study supported in part by the Agency for Healthcare Research and Quality (HS07373). This suggests a possible lack of screening effectiveness in very young women. It also supports the 2002 American Cancer Society cervical cancer screening guidelines, which recommend delay of initial screening until age 21 years or 3 years after beginning vaginal intercourse.

For the current study, researchers at the University of California, San Francisco, examined incidence trends of invasive cervical cancer in U.S. women less than 30 years old by analyzing incidence rates from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database from 1973 to 1999. Incidence rates of cervical cancer overall and squamous cell cancer specifically declined during the study period by nearly 1 percent per year. Rates of cervical adenocarcinoma increased by nearly 3 percent per year, though trends have been stable since 1990. For women younger than age 20, no significant changes were observed, but cervical cancers were rare (0-3 per million women annually).

Cervical cancer among women less than 30 years of age also is rare. To put this in perspective, the rate of breast cancer in men of all ages from 1995 to 1999 was similar to the rate of all cervical cancer in women less than 30 years old during the same period. However, because of the small number of actual observed cases, the researchers suggest caution in interpreting these trends. They point to the need for future research to address other possible explanations for the observed trends and to learn more about harms associated with cervical cancer screening in young women, including the long-term outcomes of cryotherapy and cone biopsy in large numbers of young women. Finally, the researchers call for cost-effectiveness and cost-utility analyses to craft rational policies concerning an optimal age to begin screening that maximize the benefits and minimize the harms in young women.

See "Changes in cervical cancer incidence after three decades of screening U.S. women less than 30 years old," by Pamela G. Chan, M.D., Hai-Yen Sung, Ph.D., and George F. Sawaya, M.D., in the October 2003 Obstetrics & Gynecology 102(4), pp. 765-773.

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