Abstract
This study was conducted to determine whether advancing age is an independent predictor of increased risk of high-grade pathologies among women referred for colposcopy after abnormal cervical cytology. Medical records were reviewed for women with abnormal cervical cytology who underwent colposcopy at Khon Kaen University Hospital. Logistic regression was used to determine the independent impact of age on the risk of high-grade pathologies. Mean age of the women was 42.8 years. Of 482 women, 97 (20.1%) were postmenopausal, and 92 (19.1%) were nulliparous. The rate of high-grade pathologies included cervical intraepithelial neoplasia 2-3, 99 (20.5%), adenocarcinoma in situ, 4 (0.8%), cervical cancer, 30 (6.2%), and endometrial cancer, 1 (0.2%). The prevalence of significant lesions was 26.9% (95% CI, 23.1%-31.2%). In total, 31 women had cancers (6.4%; 95% CI, 4.4%-9.0%). When controlling for smear types and parity, age was noted to be a significant independent predictor of high-grade histopathology. Women older than 35-40 years were approximately 2 times as likely to have severe histopathology as the younger women. This study illustrates the substantial risk of underlying significant lesions especially invasive cancer in Thai women with abnormal cervical cytology. Age was a significant independent factor predicting the risk of high-grade pathologies.
Highlights
Persistent infection, caused by high-risk human papillomavirus (HR-HPV), is the pivotal step in cervical carcinogenesis (Dalstein et al, 2003; Chen et al, 2011)
This study was conducted to determine whether advancing age is an independent predictor of increased risk of high-grade pathologies among women referred for colposcopy after abnormal cervical cytology
This study illustrates the substantial risk of underlying significant lesions especially invasive cancer in Thai women with abnormal cervical cytology
Summary
Persistent infection, caused by high-risk human papillomavirus (HR-HPV), is the pivotal step in cervical carcinogenesis (Dalstein et al, 2003; Chen et al, 2011). Immunological dysregulation is likely an important determinant of risk of HPV persistence among older women (Rodriguez et al, 2011) These findings theoretically contribute to the increased likelihood of developing underlying high-grade cervical pathology among older women if left unscreened. Immediate colposcopy after abnormal cytology allows underlying significant lesions to be detected and treated in a timely fashion (Manopunya, et al, 2010) This major advantage is especially beneficial for area with a high incidence of cervical cancer such as Thailand because the underlying invasive lesions are notably high across all grades of cervical smear abnormalities (Kietpeerakool et al, 2008; Kietpeerakool, et al, 2014). As clearance rate of HR-HPV infection decreased with increasing age (Bosch and Harper 2006; Kjaer, et al, 2010; Kang, et al, 2014), we hypothesized that older women with abnormal cervical cytology has an increased risk of harboring underlying significant pathology. This study was conducted to determine whether advancing age is an independent predictor of increased risk of high-grade pathology results among women referred for colposcopy after abnormal cervical cytology
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