[Are analyses of cytological cervix smears from young women more harmful than beneficial?].

Background: The Norwegian coordinated cervical cancer screening program invites women from 25 to 69 years of age to have a cytological smear from the cervix uteri analysed every third year. The aim of this study was to identify the volume of smears collected and to evaluate the consequences of having or not having this done for 24-year-old and younger women not included in the screening program and to compare the results with those for other age groups.
Material and Methods: Data were obtained from the following Norwegian Cancer Registry sources: the Cancer Registry for incident cases of cancer cervix uteri (1995-2004), the Cytology Registry for volume of cervical specimen collection (1992-2005) and outcome of smears (2004), the CIN-treatment database for the number of incident cases of cervical intraepithelial neoplasia grade 2 or 3 (2004) and the Cervix Histology Registry for histological outcome of cervical biopsies (2004). Data were displayed by age (< or = 24, 25-29, 30-69 and 70 years or older). No statistical testing was done.
Results: Cancer in the cervix uteri is extremely rare among 24 year-old and younger women (0-3 cases per year). The volume of cervix smears taken from young women has decreased over the past 10 years; in 2005 approximately 35,000 out of 440,000 smears came from young women. More smears from young women were inconclusive and more lesions were of low grade than in older women; repeat testing was therefore required more frequently in young women. More young than older women were diagnosed with grade 1 or grade 2 lesions.
Interpretation: Most lesions in young women regress spontaneously. By not collecting smears from young women, many lesions that would anyway regress spontaneously, would not be discovered and follow-up could be avoided. Prospective follow-up studies of viral processes and oncogeneses indicate that it takes many years for normal cervix cells in the uterus to develop into cancer. For most young women it makes no difference whether low grade lesions or lesions that require treatment are diagnosed at age 23, 24 or shortly after 25. With reference to data from the Norwegian Cancer Registry and international literature, we conclude that analysis of cytological cervix smears from young women is more harmful than beneficial.