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Colposcopy Often Unneeded for Cervical Lesions

Pap Smears Can Monitor Young Women's Cervical Lesions, Study Shows
WebMD Health News

Nov. 4, 2004 -- Young women need not undergo colposcopy to monitor mild cervical lesions, say researchers from the University of California at San Francisco.

Instead, Pap smears can monitor the lesions, which usually fade harmlessly away in young healthy women, according to the researchers' report in the Nov. 6 issue of The Lancet.

Colposcopy is a procedure that uses a magnifying instrument called a colposcope to examine the vagina and cervix, providing a closer look than eyesight allows. A biopsy of any cervical lesions can be done during a colposcopy.

Colposcopy works, but it's usually not needed in young women, say the researchers, who included Anna-Barbara Moscicki, MD.

Moscicki's team studied a type of low-grade cervical lesion that disappears naturally in young healthy women.

Such cervical lesions have been associated with human papillomavirus (HPV), which is common in young, sexually active women.

About 70% of sexually active young women have HPV infections, according to the study. HPV infections are linked to cervical cancer, but the association between the two is not a simple one.

"More than 70% of HPV infections are transient," write the researchers, who say that about 25% of young women develop these mild cervical lesions after an HPV infection.

Still, it's important to monitor the lesions and HPV status, since there is a chance that these mild lesions will develop into a more aggressive lesion. However, even some of the more aggressive lesions have "little risk of progression to invasive cancer in this age group," write the researchers.

To find the best monitoring method for young women, Moscicki's team studied 187 women aged 13-22 with low-grade cervical lesions.

Every four months, participants had a Pap smear, colposcopy, and an HPV test. The women also answered questionnaires on topics including their sexual behaviors and substance use.

Almost all of the cervical lesions (91%) disappeared on their own within three years, and 61% were gone within one year.

Since most of these mild cervical lesions are benign and temporary, it may be overkill to use colposcopy in young women when a less intimidating (and less costly) method -- Pap smear -- can do the job.

"Our findings suggest that the strategy of colposcopy for all adolescent and young women with [mild lesions] is unwarranted and leads to unnecessary intervention, morbidity, and cost," write the researchers. "Instead, assessment with [Pap smears] might be appropriate."

In an editorial in The Lancet, Anne Szarewski and Peter Sasieni of London's Wolfson Institute of Preventive Medicine go one step further.

"We see absolutely no role for colposcopy in adolescents as part of routine management," they write, saying Moscicki's study showed how "common and essentially meaningless" low-grade cervical lesions are in young women.

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