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Lessons From Practice: Risk of CIN 3 or Cancer Associated With an LSIL or HPV-Positive ASC-US Screening Result in Women Aged 21 to 24

Moore, Gaea MD1; Fetterman, Barbara SCT (ASCP)2; Cox, J. Thomas MD3; Poitras, Nancy PMP2; Lorey, Thomas MD2; Kinney, Walter MD4; Castle, Philip E. PhD, MPH5

Journal of Lower Genital Tract Disease:
doi: 10.1097/LGT.0b013e3181b8b024
Original Articles

Objective. To characterize the risks of cervical intraepithelial neoplasia 3 (CIN 3) and cancer in women aged 21 to 24 with human papillomavirus (HPV)-positive atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL) screening results in routine clinical practice.

Materials and Methods. Quality assurance databases containing records of screening test and histologic findings from the Regional Laboratory of the Northern California Kaiser Permanente Medical Care Program were reviewed. Numbers of LSIL and HPV-positive ASC-US results and associated cancers and CIN 3 in women aged 21 to 24 during 2003 to 2007 were tabulated, and the corresponding risks were calculated overall and by year of age.

Results. During the 5-year period from 2003 to 2007, 1,620 HPV-positive ASC-US and 2,175 LSIL were diagnosed in women aged 21 to 24, for which corresponding histologic finding is available. No invasive cancers were detected in association with LSIL and HPV-positive ASC-US screening results in this age group during this period. The risk of cancer was therefore 0% (95% CI = 0.00%-0.10%). The risk of CIN 3 associated with an HPV-positive ASC-US was 2.90% (95% CI = 2.14%-3.84%), with LSIL was 2.44% (95% CI = 1.83%-3.18%), and, for the 2 combined, the risk was 2.64% (95% CI = 2.15%-3.20%).

Conclusions. The risk of CIN 3 and cancer is low enough that management of women aged 21 to 24 with ASC-US and LSIL smears without immediate colposcopy should be considered, as is currently recommended for women aged 20 and younger.

In Brief

Risk of cervical intraepithelial neoplasia 3 or cancer in women aged 21 to 24 with low-grade squamous intraepithelial lesion or human papillomavirus-positive atypical squamous cells of undetermined significance screening tests is low enough to permit management without immediate colposcopy.

Author Information

1University of California Davis, Sacramento 2Regional Laboratory, The Permanente Medical Group, Oakland, 3University of California Santa Barbara, Santa Barbara, 4Division of Gynecologic Oncology, The Permanente Medical Group, Sacramento, CA; and 5Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD

Correspondence to: Walter Kinney, MD, Division of Gynecologic Oncology, 1650 Response Rd, Sacramento, CA 95815. E-mail:

©2010The American Society for Colposcopy and Cervical Pathology