The Correct Answer is C!

A 22-year-old woman is seen for a routine physical exam. She is currently a college student studying finance and preparing to graduate next spring. She has no prior medical history. She takes oral contraceptives but no other medications. Her family history is significant for her father who had colon cancer at age 45 and is in remission; there is no other cancer history in the family. She denies tobacco or illicit drug use. She drinks alcohol socially, on average no more than 2-3 drinks per week on the weekends. She is currently sexually active with one male partner for the last two years, and in addition to her birth control pills, they also use condoms. She has had no other partners in the past. She had a pelvic exam when she was 16 for workup for abnormal uterine bleeding.

 

Which of the following is the most appropriate management strategy for this patient’s acne?

A. Begin screening with cytology every three years
B. No screening is necessary at this time
C. Begin screening with cytology every three years
D. Begin screening with cytology and HPV testing every three years

Rationale:

According to the most recent guidelines, cervical cancer screening should begin at the age of 21 and no earlier, regardless of sexual history. Although cytologic abnormalities are found commonly in women younger than 21, clinically significant cervical lesions are very rare, and most lesions have a high likelihood of regression. In addition, annual screening is no longer recommended because of increased rates of false-positive results, and the utility is low as precancerous lesions often take years to progress to invasive cancer. In women ages 21-65, the current recommendation is for screening with cytology every three years. Alternatively, in the subgroup of women ages 30-65, screening can be done every five years if both cytology and HPV are performed. A negative high-risk HPV screen places a patient at low risk for cervical cancer, thus the longer interval is still safe. In women over the age of 65 with three consecutive negative cytology results or two consecutive negative cytology results plus HPV testing, no further screening is recommended. In this same age group, if there is a history of CIN2 or greater, screening can continue for at least 20 years.

In this patient, screening should begin with cytology every three years. Annual screening is not necessary. HPV testing is also not recommended due to the high prevalence of HPV infection in this age group.

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