What are the cervical cancer screening guidelines for an 18-year-old female, gravida 1, para 1 (G1P1), with a family history of cervical intraepithelial neoplasia 3 (CIN 3) in her mother, aged 42?

From the Guidelines

Cervical cancer screening should not be initiated in this 18-year-old female until she reaches the age of 21, at which point she should undergo cytology screening every 3 years, as the current guidelines do not recommend earlier screening for individuals with a family history of cervical dysplasia or cancer. The rationale behind this recommendation is based on the findings from the American Cancer Society and the U.S. Preventive Services Task Force, as outlined in the study by 1, which emphasizes that cervical cancer is extremely rare in women under 21, and HPV infections in adolescents and young women are typically transient and clear spontaneously without progressing to cancer. Furthermore, the study by 1 supports this approach, highlighting that cytologic abnormalities are common in women younger than 21 years, yet clinically important cervical lesions are rare, and thus screening before age 21 years is not recommended, regardless of sexual history.

The patient's family history of CIN 3 in her mother at age 42 does not alter the recommendation for screening initiation, as the guidelines do not suggest earlier screening for individuals with a family history of cervical dysplasia or cancer. The estimated average time for a high-grade precancerous lesion to progress to cervical cancer is 10 years, as noted in the study by 1, which allows ample time for identification and treatment of such lesions, supporting the recommendation to start screening at age 21.

Key points to consider in the management of this patient include:

• Screening for cervical cancer should begin at age 21 years, regardless of the age of sexual initiation or family history of cervical dysplasia or cancer.
• Women ages 21 to 29 years should receive cytology screening every 3 years.
• HPV testing should not be used for screening women in this age group, although it can be used as a reflex test for women diagnosed with ASC-US.
• The patient should be counseled about the importance of regular screening once she turns 21, regardless of her HPV vaccination status.

From the Research

Cervical Cancer Screening Guidelines

• For an 18-year-old female (G1P1) with a family history of CIN 3 in her mother at age 42, the current guidelines do not provide specific recommendations based on family history alone 2, 3, 4, 5.
• However, the American Society for Colposcopy and Cervical Pathology (ASCCP) recommends that women aged 21-29 years should have a Pap test every 3 years, and women aged 30-65 years should have a Pap test and HPV test every 5 years or a Pap test alone every 3 years 4.
• The US Preventive Services Task Force (USPSTF) also recommends cervical cancer screening every 3 years with a Pap test for women aged 21-29 years, and every 5 years with a Pap test and HPV test or every 3 years with a Pap test alone for women aged 30-65 years 3.
• It is essential to note that these guidelines are based on the risk of cervical cancer and CIN 3+, and the presence of a family history of CIN 3 may not significantly impact the screening recommendations 2, 4, 5.

Risk of CIN 3+ and Cervical Cancer

• The risk of CIN 3+ and cervical cancer is higher in women with a family history of cervical cancer or CIN 3, but the exact risk is not well established 2, 4, 5.
• A study found that the 5-year risk of CIN 3+ was 0.43% for women with HPV-negative/ASC-US results, which is similar to the risk for women with Pap-negative results 2.
• Another study found that the 5-year risk of CIN 3+ was 4.5% for women with HPV-positive/Pap-negative results, which is higher than the risk for women with Pap-negative results 5.

HPV Vaccination

• The HPV vaccine is recommended for all adolescents, ideally at ages 11-12, but it can be given through age 26 for those who did not get fully vaccinated when they were younger 6.
• The vaccine has been shown to be effective in preventing cervical precancer and cancer associated with HPV16/18 infection in young women who were not initially infected with hrHPV or HPV16/18 6.
• However, the vaccine efficacy is lower in mid-adult women, and there is no protection against cervical precancer in mid-adult women unselected by HPV DNA status at enrollment 6.