The Effect of Changes in Cervical Cancer Screening Guidelines on Chlamydia Testing

The Evolution of Women's Preventive Services

Women's health specific to vaginal/cervical health is a relatively recent field with the first publication in 1941 by George Nicholas Papanicolaou, to the American Cancer Society communication campaign in 1945, to final adoption of Pap smears by clinicians in 1950. This lead to gains in cervical cancer control and the view that Pap smear was indeed the answer to early detection and prevention. Therefore, the visit to the doctor for a Pap smear became an annual event in every woman's life. The annual contact also made for a strategic opportunity to layer on additional services including screening for sexually transmitted disease leading to early detection and management of chlamydia. This interesting side benefit may have been the most valuable intervention in young girls' lives of the annual contact.

However, as the science of Human Papillomavirus as a causal viral agent advanced, it underscored the firm understanding that the screening of women younger than age 21 was futile and not necessary; ultimately ending in recommendations for the revision of cervical screening paradigm to utilize cytology and HPV testing starting at age 21 years. This cervical cancer screening recommendation ignored the ripple effects that change in clinician behaviors would have on sexually transmitted disease detection and intervention. Hence, Naimer et al's observed reduction in Chlamydia detection in the 14-19 year old females.

In parallel to the evolution of cervical cancer screening, the detection methods for chlamydia were also advancing, albeit not at the same pace. The observed data in Naimer et al maybe a point in time when the modus operandi for chlamydia screening still required a cervical/vaginal specimen versus a urine specimen. It is likely that observations on chlamydia incidence in age 14-19 year old females will demonstrate an increase as urine testing becomes routine. However, annual contact with a physician ensured that all aspects of women's health were addressed and thus presented as superior opportunistic visit for cancer screening, contraception, vaccination, reduction of high risk behaviors and sexual risk control.

As Women's preventive services evolve, it is important to consider the ramifications of change in recommendations on not only the target disease, but also on those screenings that are layered onto opportunistic aspects of the index screening tool/test.

Bibliography: Evolution's Empress: Darwinian Perspectives on the Nature of Women. Fisher ML, Garcia JR, Chang RS. Published May 2013 Oxford Scholarship Online.

Competing interests: None declared