Cervical Papanicolaou smear abnormalities in Inner City Bronx adolescents: Prevalence, progression, and immune modifiers

Morris Edelman, Amy S. Fox, Elizabeth M. Alderman, Wendy Neal, Alan Shapiro, Ellen J. Silver, Ilya Spigland, Mark Suhrland

Research output: Contribution to journalArticlepeer-review

35 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)184-189
Number of pages6
JournalCancer
Volume87
Issue number4
DOIs
StatePublished - Aug 25 1999

Keywords

  • Adolescent
  • Cervical intraepithelial neoplasia
  • Cytology
  • Immune deficiency
  • Papanicoloau smear

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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