Effect of Gynecologic Immaturity on Cervical Histology in Teens Undergoing Colposcopy for Cytologic Atypia (ASCUS)

Abstract

Background There is still no consensus concerning the need for colposcopy when the Pap smear shows ASCUS. However, physiologic and behavioral factors associated with increased mitotic activity at the cervical squamo-columnar junction (squamous-metaplasia) appear to increase the likelihood of neoplastic transformation in association with ASCUS. Since the squamo-columnar junction becomes more mitotically active at menarche, exposure to carcinogens during this potentially vulnerable period could predispose teens to squamous interepithelial lesions (SIL). We hypothesized that among teens who undergo colposcopy for ASCUS cytology, those who report initiating sexual activity within 2 yrs of menarche are more likely to have SIL histology than are those who report that they became sexually active 3 or more years after menarche. Methods We studied a multiracial group (36% white, 44% black, 14% hispanic, 6% other) of 36 teens (18±2 yrs) referred for coloposcopic evaluation of ASCUS. None of the study subjects had cervical or vaginal infections or an identifiable source of lower genital tract inflammation when the index Pap smear was obtained. Results On average menarche occurred at 12 ± 1 yrs and the teens initiated sexual activity 2 ± 1 yrs later (14 ± 2 yrs). The 21 teens who became sexually active within 2 years of menarche were older at menarche (12 ± 1 v 11 ± 1 yrs; p = .009) and younger at first intercourse (13 ± 2 v 14,5 ± 1 yrs; p = .02) but were no more likely to have other physical findings suggestive of gynecologic immaturity (large ectropion/high vaginal pH), or other physiologic or behavioral risk factors for the cervical dysplasia. Overall 50% of the 36 teens smoked cigarettes, 75% had been pregnant, 72% had born a child, 62% douched at least monthly, 12% had been victims of childhood sexual abuse, 75% had had ≥3 sexual partners (6 ± 3), and 20% of the index Pap smears were performed postpartum. Contrary to the study hypothesis, there were no group differences in colposcopy findings; 20 (56%) of the 36 teens had SIL (15 LSIL & 5 HSIL); 6 (17%) had ASCUS; & 10 (27%) had normal cervical biopsies. Those with SIL did not differ from those with more benign biopsies with regard to any of the physiologic or behavioral risk factors for the cervical dysplasia we studied. Conclusion Our findings do not support the hypothesis that gynecologic immaturity is a risk factor for SIL in teens with ASCUS. However, the prevalence of SIL in teens with ASCUS is high enough to justify immediate colposcopic evaluation in this population.