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 journalArticle

33 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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