WHITE SULPHUR SPRINGS, W. VA. — Most abnormal cervical cytology in adolescent women will be low-grade squamous intraepithelial lesions, and will regress to normal by the follow-up exam, Andrea Wininger, M.D., said at the annual meeting of the South Atlantic Association of Obstetricians and Gynecologists.
Her retrospective chart review included 217 abnormal Pap smears among women aged 13-17 years. Low-grade squamous intraepithelial lesions (LSIL) were seen in 57%, atypical squamous cells of undetermined significance (ASCUS) in 30%, high-grade squamous intraepithelial lesions (HSIL) in 7%, and atypical squamous cells in which HSIL cannot be excluded (ASC-H) in 5.5%.
Regression was high among all abnormal smears. By the follow-up exam, (mean 11 months later) 65% of LSIL, 67% of ASCUS, 57% of ASC-H, and 55% of HSIL had regressed. Of the 129 women (60%) who returned for their follow-up exam, 64% had normal cytology.
Rates of progression were low, said Dr. Wininger of the University of South Carolina, Columbia. Only 2.4% of ASCUS progressed to HSIL and 7% of LSIL progressed to HSIL.
That's good news for these young women, many of whom can be managed conservatively. But getting them to return for that critical follow-up isn't easy. “Forty percent didn't come back for their second smear, which is a very high rate of noncompliance, and this is one of the factors that puts this group at high risk for cervical dysplasia,” she said.
The tendency toward noncompliance, plus a proclivity for high-risk sexual behavior, makes early education about sexual health a must. “Early, aggressive education for these patients is critical to get them to understand the relationship between risky sexual behavior and sexually transmitted infections.”
She also recommended routine screening for sexually transmitted disease among all adolescents who have abnormal cytology, as her study found a significant association between chlamydia infection and progressing abnormal cytology. But she found no association between abnormal cytology and gonorrhea, trichomoniasis, genital warts, Candida, or bacterial vaginosis.