title: Outcomes of a Decade of Routine Cervical Screening in a Canadian Adolescent Obstetrics Clinic.
abstract: OBJECTIVE
  New recommendations from the Ontario Cervical Cancer Screening Program indicate that initiation of screening should be delayed to age 21. However, there is sparse evidence pertaining to pregnant adolescents. Our objective was to determine whether early cervical cancer screening in pregnant adolescents confers an advantage over delayed screening in the prevention of cervical carcinoma.
  
  
  METHODS
  We conducted a retrospective cohort study of cervical cancer screening in all pregnant adolescents receiving antenatal care through an obstetrics clinic for adolescents between 2000 and 2010. Clinic attendees had an antenatal and/or postpartum Pap smear, with follow-up according to standard recommendations. Results were recorded together with information on regression, persistence, or progression of abnormal cytology, colposcopy referrals, and cervical biopsies. There is a single regional colposcopy clinic.
  
  
  RESULTS
  At least one Pap smear result was documented in 365 of the 388 patients. Of these 365 smears, 88 had abnormal cytology, 76 (86.4%) of which were reported as atypical cells of undetermined significance/low-grade squamous intraepithelial lesion, 11 (12.5%) high-grade squamous intraepithelial lesion (HSIL), and one atypical glandular cells (1.1%). Follow-up cytology was available for 78 patients. No patient lost to follow-up had subsequent referrals for colposcopic assessment in the region. Overall, cytologic abnormalities regressed in 75 (96.1%), persisted in two (2.6%), and progressed in one patient (1.3%). Twenty-three patients (of 365) required a total of 68 colposcopy visits and 17 biopsies, but ultimately only three loop electrosurgical excision procedures (LEEPs) and one laser vaporization were performed. Only one LEEP in a 20-year-old demonstrated HSIL.
  
  
  CONCLUSIONS
  This population of pregnant adolescents had a high incidence of low-grade cervical abnormalities with a high rate of regression. Routinely screening these pregnant adolescents resulted in numerous repeat visits, repeat Pap smears, and colposcopy referrals, and led to patient anxiety and systemic costs. Not a single case of cervical cancer was prevented that would not otherwise have been identified by adherence to the new guidelines.
authors.affiliation: Department of Obstetrics & Gynecology, Queen's University, Kingston, ON.
authors.forename: Ann
authors.initials: A
authors.lastname: Korkidakis
authors.affiliation: Department of Obstetrics & Gynecology, Queen's University, Kingston, ON.
authors.forename: Peter
authors.initials: P
authors.lastname: Bryson
authors.affiliation: Department of Obstetrics & Gynecology, Queen's University, Kingston, ON.
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Jamieson
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002170:Canada / Q000453:epidemiology; D002277:Carcinoma / Q000453:epidemiology / Q000473:pathology; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D017063:Outcome Assessment, Health Care; D065006:Papanicolaou Test / Q000706:statistics & numerical data; D011230:Precancerous Conditions / Q000175:diagnosis / Q000453:epidemiology; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000706:statistics & numerical data; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000473:pathology
keywords: Pap test; adolescence; cervical cancer; cervical cytology; obstetrics; teen pregnancy