To describe clinical presentation and treatment in women younger than 25 years referred to the Royal Women’s Hospital colposcopy clinic, before implementation of the National Human Papillomavirus Vaccination Program.
Retrospective cohort analysis of women younger than 25 years referred to a tertiary hospital colposcopy clinic between 1998 and 2007. Clinical presentation and correlation between cervical cytology, biopsy, and histology at treatment was examined.
Approximately 14,635 colposcopies were undertaken in 4104 women (median age, 22 years); 3051 had abnormal referral cytology, of whom, 23.8% had high-grade disease on punch biopsy. High-grade disease was found in 15.1% of those with possible low-grade or low-grade cytology (293/1932), 42.4% of those with possible high-grade or high-grade cytology (474/1119). Sensitivity and specificity of colposcopy for high-grade disease (high-grade epithelial abnormality, adenocarcinoma in situ, cervical cancer up to 2 years follow-up) was 60.0% and 82.3%, respectively. Thirty-nine percent (n = 1180) with abnormal cytology had treatment, of which, 66.6% was ablative. Histological CIN3+ was found in 53.8% of those with a previous high-grade punch biopsy (126/234) at excisional treatment, and 23.0% of those with a previous low-grade punch biopsy (20/87) (relative risk, 2.3 [CI, 1.6–3.5]). Four cancers were detected (0.1% of the total cohort, 0.5% of those with a high-grade biopsy, and 1.7% of those with a high-grade biopsy who underwent excisional treatment.)
Before vaccination, young women experienced a high real-time burden of high-grade disease and high rates of intervention. These baseline data contribute to monitoring of HPV vaccination and revised cervical screening strategies.
Women younger than 25 years with a high-grade cervical biopsy had a greater than 50% chance of CIN3+ on operative histology, including 0.5% risk of malignancy.
1Oncology and Dysplasia Unit, 2University of Melbourne, Department of Obstetrics and Gynaecology, Royal Women’s Hospital; 3Department of Gynaecology, Royal Children’s Hospital, Melbourne, Victoria, Australia; and 4BGS Global Hospitals, Bangalore, India.
Correspondence to: Yasmin L. Jayasinghe, MBBS, FRANZCOG, PhD, Department of Obstetrics and Gynecology, University of Melbourne, Royal Women's Hospital, Level 7, Corner Grattan St and Flemington Rd Parkville, Australia, 3052. E-mail: firstname.lastname@example.org
Declaration of Interests: No funding sources to disclose. The authors have no financial or commercial interests with respect to the material in this paper nor do they have any conflicts of interest to declare. Dr Jayasinghe has been provided with scholarship support from RANZCOG Research Foundation, Cancer Council of Victoria, the Royal Australasian College of Physicians (Novartis Scholarship for Sexual Health Research), and grant support from the Victorian Cancer Agency for examining risk factors for cervical cancer in young women and unrelated studies. Mr. Wrede is an Honorary Board member of the Victorian Cytology Service, which performs more than 50% of the cervical cytology in Victoria. He is also a member of the multidisciplinary working party for the development of clinical management guidelines for the prevention of cervical cancer.
Institutional Review Board status: The study received audit approval by the Royal Women’s Hospital Human Research Ethics Committee.