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High Rates of High-Grade Cervical Dysplasia in High-Risk Young Women With Low-Grade Cervical Cytology

Daily, Laura R. MD1; Erickson, Britt K. MD2; Pasko, Daniel N. MD1; Straughn, J. Michael Jr MD3; Huh, Warner K. MD3; Leath, Charles A. III MD3

Journal of Lower Genital Tract Disease: July 2018 - Volume 22 - Issue 3 - p 207–211
doi: 10.1097/LGT.0000000000000381
Original Research Articles: Cervix and HPV

Objective The aim of the study was to determine rates of cervical intraepithelial neoplasia (CIN) 2 or greater in high-risk, racially diverse, young women with low-grade cytology.

Materials and Methods After institutional review board approval, a cross-sectional study of 21- to 24-year-old women with low-grade cytology (atypical squamous cells of undetermined significance, high-risk human papillomavirus+, low-grade squamous intraepithelial lesion, or human papillomavirus+ only) managed with colposcopy at our university-based clinic between May 2011 and April 2013 were identified. Demographics and pathologic data were collected including age, race, parity, smoking status, screening history, and histology. Student t test and χ2 tests were used to compare women with and without CIN 2 or 3. Univariate analysis was performed with demographic data.

Results One thousand fifty-eight women with a mean (SD) age of 22.5 (1.1) were included. Most patients (59.5%) were parous, 36.1% were smokers, and most (52.9%) were black. These patients were considered high risk because of their lower socioeconomic status, minority status, lack of insurance, or having Medicaid and therefore had limited access to preventative health care. Based on colposcopy, the prevalence of CIN 2+ was 19.1%: 13.9% (95% CI = 11.9–16.1) CIN 2 and 5.1% (95% CI = 3.9–6.6) CIN 3. There was an overall prevalence of 4.7% (95% CI = 3.7%–6.3%) of CIN 3 from excisional pathology from the 157 of 185 patients who returned for a recommended excisional procedure. Smoking (odds ratio = 1.64, 95% CI = 1.2–2.25) and a history of high-grade cytology (odds ratio = 2.06, 95% CI = 1.02–4.01) were associated with CIN 2/3.

Conclusions High prevalence of CIN 2/3 in young women with low-grade cervical cytology in this population suggests that it may be prudent to consider alternative surveillance such as colposcopy in similar high-risk populations.

Alternative surveillance, such as colposcopy, may be prudent in high-risk young women with low-grade Pap smears due to risk of high-grade dysplasia.

1Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL;

2Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN; and

3Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL

Reprint requests to: Laura R. Daily, MD, University of Alabama at Birmingham, 176F Room 5329, 619 19th St S, Birmingham, AL 35294. E-mail:

W.K.H. served as a consultant for TheVax Genetics Vaccine Co. The the authors have declared they have no conflicts of interest.

The study was support was funded in part by NIH T32-CA091078 to B.K.E. and 5K12HD0012580-14 to C.A.L.

This study was approved by the institutional review board at the University of Alabama at Birmingham.

Poster presentation at the Annual Clinical Meeting of the American Congress of Obstetricians and Gynecologists, Chicago, IL, April 28, 2014.

Copyright © 2018 by the American Society for Colposcopy and Cervical Pathology