title: Cervical cancer screening and subsequent procedures in women under the age of 25 years between 2007 and 2013 in France: a nationwide French healthcare database study.
abstract: Cervical cancer screening in young women may lead to the detection of lesions with a high potential for spontaneous regression and no benefit of surgery. French guidelines recommend initiating cervical cancer screening by the Pap test from the age of 25 years. To date, no French nationwide study has assessed cervical cancer screening in young women and the related subsequent work-up and surgical procedures among screen-positive women. Using data from the French national healthcare databases (around 50 million beneficiaries), annual and 3-year Pap test screening rates were calculated among women aged 15-24 years between 2007 and 2013. Cervical excisional procedures were assessed during the 15-month period following a first Pap test in women aged 20-24 years in 2007 and 2012. About 10% of the almost six million women aged 15-65 years with at least one annual Pap test were under the age of 25, mainly women aged 20-24 years, in whom the 3-year screening coverage was 35.5% in 2013. In screened women aged 20-24 years, human papillomavirus testing rates increased markedly over the study period (+105%) and surgical management became less conservative with an increased rate of both conization (+16.5%) and other excisional treatments (+74.5%). Nevertheless, because of the overall decrease in screening coverage, the absolute yearly number of women who underwent conization decreased from 1974 to 1766 between 2007 and 2012. Higher adherence to guidelines is needed to reduce the burden of surgical treatment that is potentially associated with adverse obstetric outcomes among women under the age of 25 years.
authors.affiliation: French National Health Insurance (Caisse Nationale de l'Assurance Maladie des Travailleurs Salariés, CNAMTS).
authors.forename: Géric
authors.initials: G
authors.lastname: Maura
authors.affiliation: French National Health Insurance (Caisse Nationale de l'Assurance Maladie des Travailleurs Salariés, CNAMTS).
authors.forename: Christophe
authors.initials: C
authors.lastname: Chaignot
authors.affiliation: French National Health Insurance (Caisse Nationale de l'Assurance Maladie des Travailleurs Salariés, CNAMTS).
authors.forename: Alain
authors.initials: A
authors.lastname: Weill
authors.affiliation: French National Health Insurance (Caisse Nationale de l'Assurance Maladie des Travailleurs Salariés, CNAMTS).
authors.forename: François
authors.initials: F
authors.lastname: Alla
authors.affiliation: French HPV Reference Laboratory (Centre National de Référence des papillomavirus humains), Institut Pasteur.|Groupe Hospitalier Pitié-Salpêtrière, Public Assistance - Paris Hospitals, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Heard
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000000981:diagnostic imaging / Q000473:pathology / Q000821:virology; D019092:Conization / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D065006:Papanicolaou Test / Q000592:standards / Q000706:statistics & numerical data; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000821:virology; D014626:Vaginal Smears / Q000592:standards / Q000706:statistics & numerical data; D055815:Young Adult