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- Page navigation anchor for RE: Starting cervical cancer screening at 25 years of ageRE: Starting cervical cancer screening at 25 years of age
Dear Editor,
I am writing in regard to Popadiuk et al.’s commentary on the start age of cervical cancer screening. The statement the Canadian Task Force recommends screening to begin at age 25 needs further clarification. The commentary does not mention the strength of the recommendation, nor how it should be applied. While in the Task Force’s 2013 paper, the Task Force specifies it is a weak recommendation, and screening should not be uniformly started at the age of 25. Instead the decision of when to start screening, in the 25 to 30 age group, should be based on the risk and preferences of each individual women.1
As a family physician in Alberta, I have many low risk patients in this age group that have made the informed decision to wait until 30 for their first PAP. I feel it is particularly important to have this discussion, instead of just starting to screen at 25 years old, due to the invasiveness and opportunity cost of the procedure.
Also, I found it notable only 2 provinces have updated their guidelines to align with the Task Force recommendations, as soon the 2013 Canadian Task Force guidelines may itself need to be updated. Many jurisdiction worldwide including the Netherlands, Italy, Norway, England, Australia and New Zealand have or are in the process of changing to primary HPV screening with reflex cytology. The reasons cited are increased sensitivity, less frequent screening intervals, decreased cost and a projected decrease in in...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: Starting cervical cancer screening at 25 years of ageRE: Starting cervical cancer screening at 25 years of age
Dear Editor
I read with interest Dr. Popadiuk’s commentary on cervical cancer screening at 25 years of age. I am familiar with the powerful Onco-Sim tool, but I continue to have nagging concerns that by doing right for the majority, we may inadvertently leave behind the most disadvantaged.While some of my concerns may be emotional, likely due to the impact of having witnessed young women with cervical cancer, I also know that it has been challenging to show the benefit of widespread screening for these aggressive cancers seen in some young woman, and thus I set emotions aside. I fully accept that provinces have to make resource allocation dollars, yet what continues to concern me is:
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1. The young women who are unvaccinated, especially those who may also have other risk factors for cervical cancer (smoking, poor nutrition, sex trade, victims of early abuse, etc.). Is twenty five early enough to be able to detect pre-invasive or micro-invasive disease?
2. The missed opportunity to find a lesion when a relatively small loop excision, or a fertility preserving procedure could remove it, compared to a more potentially damaging excision or radical procedure, later. When this was examined in Britain, comparing onset at age 20 to age twenty-five, fully 58% of the admittedly low number cancers detected, would have been at a micro-invasive stage1. To what extent are we prepared to go to enable young women a treatment that could improve survival and preser...Competing Interests: None declared.