Prevalence of High-Grade Cervical Dysplasia in an Inner City Adolescent Population

Abstract

The purpose of this study was to determine the prevalence of high-grade squamous intraepithelial lesions (HSIL) in an adolescent population diagnosed at an urban university hospital. This study was a retrospective review of Pap smear diagnoses from January 1997 through August 2010. Patients ≤20 years were compared with records of patients ages 21–30 and >30 years and also with US averages. Analyses were conducted using the Pearson chi-square test. A total of 19,481 Pap smear diagnoses of African-American patients were reviewed: 2,229 for patients ≤20 years old, 5,294 for patients 21–30 years old, and 11,958 for patients >30 years old. The prevalence of HSIL in study patients ≤20 year age group was higher (1.62 %) than that of the 21–30 year age group (1.38 %) and the >30 year age group (1.10 %). The difference between the ≤20 year age group and the >30 year age group was statistically significant (p=0.0478) whereas the difference betweeen the ≤20 year age group and the 21–30 year age group was not (p=0.458). Follow-up management of seventeen patients ≤20 years old with HSIL indicated that eleven (64.7 %) patients had a persistent diagnosis of HSIL, four (23.5 %) patients had a diagnosis of low-grade squamous intraepithelial lesion (LSIL), and two (11.8 %) patients had no evidence of intraepithelial lesion or malignancy on subsequent colposcopy or conization. Our study data supports published reports of a high prevalence of HSIL in adolescents. However, the prevalence of malignant transformation in this cohort is still relatively low. As such, we agree with current guidelines posited by the American College of Obstetrics and Gynecology (ACOG), American Cancer Society (ACS), and US Preventive Service Task Force (USPSTF). Room for additional research in the African-American cohort is encouraged given their underrepresentation in research.