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Sharon A. Mangan, MD; Lori A. Legano, MD; Carolyn M. Rosen, MD; Margaret T. McHugh, MD; Arthur H. Fierman, MD; Benard P. Dreyer, MD; Vincent J. Palusci, MD; Barbara Winkler, MD

Arch Pediatr Adolesc Med. 1997;151(5):481-484.

Abstract
Objective
To determine the secular trend in the prevalence of cervical dysplasia as evidenced by abnormal Papanicolaou smear results in sexually active adolescents.

Design
Descriptive case series.

Setting
Outpatient department of an urban public hospital.

Participants
All sexually active adolescents with Papanicolaou smear results recorded during 2 periods: January 1, 1982, through December 31, 1983 (n=577), and January 1, 1992, through December 31, 1993 (n=871).

Measurements
Age, ethnicity, patient care location in which the Papanicolaou smear preparation was performed, and Papanicolaou smear results were obtained for each patient. For patients with more than 1 Papanicolaou smear result during the specified period, only the first result was included in this study. Papanicolaou smear results were classified according to the Bethesda system as within normal limits, benign cellular change, atypical squamous cells of undetermined significance, low-grade squamous intraepithelial lesion, or high-grade squamous intraepithelial lesion. Any Papanicolaou smear classified as atypical squamous cells of undetermined significance or low- or high-grade squamous intraepithelial lesion was defined as abnormal.

Results
The prevalence of abnormal Papanicolaou smear results was 2.8% in 1982 through 1983 vs 11.7% in 1992 through 1993; prevalence odds ratio was 4.7 (95% confidence interval, 2.7-8.3). The higher rate of abnormal Papanicolaou smear results in 1992 through 1993 persisted after controlling for age, patient care location, and ethnicity in a logistic regression model (adjusted prevalence odds ratio, 5.0; 95% confidence interval, 2.8-8.9). The prevalence of benign cellular change was 8.7% in 1982 through 1983 vs 20.1% in 1992 through 1993; prevalence odds ratio was 2.7 (95% confidence interval, 1.9-3.8).

Conclusions
The prevalence of abnormal Papanicolaou smear results has significantly increased in the last decade in sexually active adolescents seen at a city hospital clinic. The results of this study emphasize the importance of routine Papanicolaou smear screening for all sexually active female adolescents.

Arch Pediatr Adolesc Med. 1997;151:481-484

Author Affiliations
From the Departments of Pediatrics (Drs Mangan, Legano, Rosen, McHugh, Fierman, and Dreyer) and Pathology (Dr Winkler), New York University School of Medicine, New York City; and the Department of Pediatrics, Michigan State University College of Human Medicine, Lansing (Dr Palusci).

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