Cervical Papanicolaou smear abnormalities in inner city Bronx adolescents - Prevalence, progression, and immune modifiers

BACKGROUND, The aim of this study was to quantify the prevalence of cervica l smear abnormalities in sexually active adolescents and identify the effec t of immune-modifying conditions. METHODS. Two hundred seventy-one females ages 13-22 years attending a clini c for sexually transmitted disease (STD) evaluation had cervical Papanicolo au (Pap) smears and completed sexual history questionnaires. Results of all follow-up Pap smears were obtained. Medical charts were available for 54 p atients with cytologic follow-up and were reviewed for the presence of immu ne-modifying conditions. Follow-up smear results for patients with and with out immune-modifying conditions were compared. Abnormality rates for all ce rvical smears seen in 1995 at Montefiore Medical Centre were also obtained. RESULTS. The smear abnormality rate for adolescents was 20.7% (abnormal squ amous 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 wa s 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 dete rmined, Of 14 patients with an immune-modifying condition (9 HIV positive p atients, 3 receiving oral steroids, 1 liver transplant patient receiving st eroids, and 1 with intestinal lymphangiectasia), 11 (78.6%) developed or ma intained an abnormality on cytologic follow-up. Of 40 patients with no iden tifiable 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 gy necologic monitoring. (C) 1999 American Cancer Society.