The prevalence of HPV associated cervical intraepithelial neoplasia in women under age 21: who will be missed under the new cervical cancer screening guidelines?

Study Objective: To quantify the number of adolescent females < age 21 years with pre-cancerous cervical lesions (cervical intraepithelial neoplasia grade 2 or higher (CIN 2+) or adenocarcinoma in situ (AIS)) in Connecticut in the time period before new cervical screening recommendations went into effect and identify any demographic associations with a diagnosis of CIN 3.

Design: Descriptive analysis, surveillance.

Setting: CIN 2+/AIS precancerous cervical lesions have been reportable conditions in Connecticut since 2008 for the purpose of public health surveillance.

Participants: All women < 21 years old with pre-cancerous cervical lesions diagnosed between 2008 and 2010 (N = 681).

Results: Of the 681 reports, 478 (70.2%) women had CIN 2, 92 had CIN 2/3 (13.5%), and 110 (16.2%) had CIN 3. CIN 3 occurred at an average rate statewide of 19/100,000 per year for women ages 13-20. The majority of adolescents with pre-cancerous cervical lesions CIN 2+/AIS (70%) were 19 and 20 years of age. CIN 3 vs CIN 2 is not found to be associated with age, insurance status, specimen collection year, or living in a non-urban vs urban county.

Conclusion: The majority of cases of pre-cancerous cervical lesions in adolescents diagnosed before new screening recommendations were in effect are CIN 2 and therefore, likely to regress. CIN 3 has been infrequently found in adolescent females under age 19 years; however, under the new screening guidelines, 110 cases of CIN 3 including 77 in women 19-20 years could have been missed in the adolescent female in Connecticut from 2008-2010 (54.4 per 100,000 per year for 19-20 year olds). Based upon these findings, it is necessary that clinicians educate adolescents and parents about the new screening guidelines and the importance of establishing regular cervical cancer screening beginning at age 21.