Human papillomavirus disease and vaccines in adolescents.

Review of the most recent evidence indicates that screening for cervical cancer in females younger than 21 years of age likely leads to more harm than good. In addition, screening during adolescence has not lead to decreased cervical cancers in this age group. The rate of cervical cancer remains extremely low in adolescents. In contrast, abnormal cytology is extremely common, of which most is benign. Hence, referral to colposcopy is unnecessary and costly. New guidelines recommend cervical cancer screening to start at the age of 21 years and to not be based on sexual behavior. The exception is for immunocompromised girls, who should be screened once intercourse is initiated, since they are at increased risk for cervical cancer. Recently, we have also broadened our understanding about human papillomavirus-associated disease in men. In this chapter, we cover the advances in science that have led to new screening recommendation for cervical cancer and the advances in prevention: vaccines for both adolescent women and men.