When does a young woman need a pap smear? - Margot Kingston, Clinical Nurse Manager, Family Planning Queensland

 

There is overwhelming evidence that there is no benefit for young women to have Pap smears before the age of 18 as they have extremely low risk of cervical cancer. New National Health and Medical Research Council (NHMRC) Guidelines, implemented July 2006, are based on evidence now available about the role of human papilloma virus (HPV) in the development of cervical cancer. It is widely accepted that cervical cancer is caused by this virus in over 99.7% of cases

HPV is common in early years of a woman's sexual activity (it is almost always sexually transmitted); the incidence peaks in the first five years after women become sexually active and there is a greater than 50% chance of acquiring HPV after unprotected sexual intercourse. In some quarters HPV is referred to as "the common cold of sexual activity"; most people get it, the immune system deals with it and there is rarely any serious outcome from it in healthy individuals.

It has been demonstrated that the majority of Pap smear abnormalities experienced by young women are most likely to be the result of an active infection with HPV, and that 98% of these infections will resolve spontaneously. The spontaneous resolution of the changes occurs over a one- to two-year period and early intervention is not only unnecessary but also undesirable. In fact, it is the over treatment of these relatively common changes that causes not only physical, emotional and possible financial distress but is also associated with poorer obstetric outcomes in situations where the cervix has been adversely affected by surgery.

This evidence supports the National Cervical Screening Policy that recommends that all women who have ever been sexually active should commence having Pap smears between the ages of 18 to 20 years, or one to two years after first sexual intercourse, which ever is later. In general, this means that:

• women under the age of 18 do not require a Pap smear regardless of previous length of time since becoming sexual active
• women who have been sexually active for more than one to two years and are over 18 years of age should be encouraged to have a Pap smear
• women of any age who have symptoms such as unexplained vaginal bleeding should have appropriate clinical assessment

It is important to discuss cervical screening with young women and advise them the most appropriate age at which to commence Pap smears. There is no evidence that supports encouraging women under 18 years of age to have a Pap smear. The focus of investigations in sexually active young women should be the detection of sexually transmissible infections such as chlamydia. Broadening the participation of young sexually active people participating in screening for chlamydia will have far greater health benefits than overzealous promotion of Pap smears in women under 18 years of age.

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