Increased prevalence of abnormal Papanicolaou smears in urban adolescents
S. A. Mangan, L. A. Legano, C. M. Rosen, M. T. McHugh, A. H. Fierman, B. P. Dreyer, V. J. Palusci and B. Winkler
Department of Pediatrics, New York University School of Medicine, New York City, USA.
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, lowgrade 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.
