ACOG Committee Opinion No. 436: evaluation and management of abnormal cervical cytology and histology in adolescents.

Abstract

The management of abnormal cervical cytology in adolescents differs from that of the adult population. Cervical cancer is almost nonexistent in adolescents, yet human papillomavirus (HPV) infection is very common in this population. In the past 5 years there has been significant advancement in the management of HPV-related diseases in adolescents. The publication of the American Society of Colposcopy and Cervical Pathology 2006 consensus guidelines has led to major changes in the prevention and management of cervical disease in adolescents. With the availability of the HPV vaccination (since 2006), it is expected that these guidelines will continue to change. The American Society of Colposcopy and Cervical Pathology guidelines now advise against HPV testing and recommend against treatment of low grade squamous intraepithelial lesions or cervical intraepithelial neoplasia 1. In addition, among adherent adolescents, treatment of cervical intraepithelial neoplasia 2 also should be deferred. These new guidelines were established to minimize the potential negative impact that treatment can have on future pregnancy outcomes, while taking advantage of the natural history of HPV in young women.