title: Findings and Outcomes in a Prevaccination Cohort of Women Younger Than 25 Years Attending a Tertiary Colposcopy Service.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.)
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Yasmin L
authors.initials: YL
authors.lastname: Jayasinghe
authors.forename: Rani
authors.initials: R
authors.lastname: Bhat
authors.forename: Michael
authors.initials: M
authors.lastname: Quinn
authors.forename: C David H
authors.initials: CD
authors.lastname: Wrede
authors.forename: Jeffrey H J
authors.initials: JH
authors.lastname: Tan
mesh_terms: D000293:Adolescent; D001706:Biopsy; D003127:Colposcopy; D003584:Cytological Techniques; D003955:Diagnostic Tests, Routine; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D060787:Neoplasm Grading; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy; D055815:Young Adult