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Cervical Papanicolaou smear abnormalities in inner city Bronx adolescents
Author(s) -
Edelman Morris,
Fox Amy S.,
Alderman Elizabeth M.,
Neal Wendy,
Shapiro Alan,
Silver Ellen J.,
Spigland Ilya,
Suhrland Mark
Publication year - 1999
Publication title -
cancer cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(19990825)87:4<184::aid-cncr4>3.0.co;2-#
Subject(s) - medicine , ascus (bryozoa) , papanicolaou stain , squamous intraepithelial lesion , gynecology , abnormality , obstetrics , colposcopy , cervical intraepithelial neoplasia , cervical cancer , cancer , botany , ascospore , spore , psychiatry , biology
BACKGROUND The aim of this study was to quantify the prevalence of cervical smear abnormalities in sexually active adolescents and identify the effect of immune‐modifying conditions. METHODS Two hundred seventy‐one females ages 13–22 years attending a clinic for sexually transmitted disease (STD) evaluation had cervical Papanicoloau (Pap) smears and completed sexual history questionnaires. Results of all follow‐up Pap smears were obtained. Medical charts were available for 54 patients with cytologic follow‐up and were reviewed for the presence of immune‐modifying conditions. Follow‐up smear results for patients with and without immune‐modifying conditions were compared. Abnormality rates for all cervical smears seen in 1995 at Montefiore Medical Center were also obtained. RESULTS The smear abnormality rate for adolescents was 20.7% (abnormal squamous cells of undetermined significance [ASCUS], 12.2%; low grade squamous intraepithelial lesion [LGSIL], 7.7%; high grade squamous intraepithelial lesion [HGSIL], 0.7%) compared with all adult females, for whom the rate was 13.2% (ASCUS, 9.9%; LGSIL, 2.5%; HGSIL, 0.6%; carcinoma 0.2%) ( P < 0.0002). Of 20 initial ASCUS patients, 6 (30%) showed LGSIL or HGSIL on follow‐up. Chart review allowed the clinical immune status of 54 patients to be determined. Of 14 patients with an immune‐modifying condition (9 HIV positive patients, 3 receiving oral steroids, 1 liver transplant patient receiving steroids, and 1 with intestinal lymphangiectasia), 11 (78.6%) developed or maintained an abnormality on cytologic follow‐up. Of 40 patients with no identifiable immune‐modifying condition, 11 (27.5%) developed or maintained an abnormality on cytologic follow‐up ( P < 0.00082). CONCLUSIONS Sexually active adolescents are at higher risk of developing a significant cervical smear abnormality, especially LGSIL. Patients with an atypical Pap smear or immune‐modifying condition require more attentive gynecologic monitoring. Cancer (Cancer Cytopathol) 1999;87:184–9. © 1999 American Cancer Society.