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

Daily, L.R.; Erickson, Britt; Pasko, Daniel N.; Straughn, J. Michael; Huh, Warner K.; Leath, Charles A.

doi:10.1097/lgt.0000000000000381

Cited by 6 publications

(8 citation statements)

References 30 publications

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“…Some authors have found progression rates for CIN 1, CIN 2, and CIN 3 of 5%, 10%, and 12%, respectively . Daily et al observed a high rate of histological CIN 2 or CIN 3 in a group of high‐risk patients with low‐grade cytological dysplasia (19.1%) . Herbert et al also found an increased rate of CIN 3 in women aged 20‐24 years despite falling screening coverage .…”

Section: Discussionmentioning

confidence: 99%

“…Some authors have shown that sexual activity begins earlier in some populations, and this could lead to an earlier development of high‐grade lesions in younger patients . Daily et al highlighted that this age limit is based on studies of insured patients with excellent access to health care, and its implementation in developing countries or high‐risk populations should be evaluated . Other authors, however, state that lowering the minimum age for screening could lead to overtreatment with untoward effects .…”

Section: Discussionmentioning

confidence: 99%

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Distribution of cervical lesions in young and older women

Arco

Ayala

García

et al. 2019

Diagnostic Cytopathology

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Introduction Age range for cervical screening varies widely between countries. In addition, sexual behavior has changed, life expectancy is increasing, and new insights have been gained into the pathogenesis of HPV infection. Our aim is to evaluate the distribution of cervical lesions in young and older patients. Methods Review of all cervical smears diagnosed in a public institution (2010‐2017) and a private institution (2016‐2017) in Madrid, Spain. We have included all women aged younger than 30 and older than 65 years with atypical smears (n = 1573). Results Women younger than 30 years were diagnosed with ASCUS, ASC‐H, LSIL, and HSIL in 47%, 5.3%, 45.17%, and 2.6% of atypical cases, respectively. Women older than 65 years were diagnosed with ASCUS, ASC‐H, LSIL, HSIL, and SCC in 38%, 12.39%, 16.8%, 13.27%, and 19.5% of atypical cases, respectively. Medical records of patients from the public institution were reviewed. Of note, 76.3% of young women showed negative smears at follow‐up and 14.1% showed high‐grade dysplasia (HGD). Mean ages for low‐grade and HGD were 24.7 and 25.7 years, respectively. HGD was found in 37.9% of women with histological examination (33.5%). As for older patients, 25% of them had no Pap smears performed before age 65, and in 60% of the previously screened women, the screening program had not been used adequately. Mean age of first smear was 69.5 years. Carcinoma was subsequently detected in 20.7% of patients. Conclusions Current guidelines seem to be adequately preventing carcinoma in young women. However, screening adherence should be encouraged to detect important lesions in both age groups, especially among older women.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Distribution of cervical lesions in young and older women

Arco

Ayala

García

et al. 2019

Diagnostic Cytopathology

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“…The change in clinical practice pattern and selective colposcopy examination has led to a decrease of follow‐up rates in women with ASC‐US/hrHPV+ since 2013 and provides a possible explanation for the higher detection rates among women aged <25 years who undergo testing with the Cervista and Aptima platforms. Recent studies have found a high prevalence of CIN2/3 in women aged 21‐24 years with ASC‐US cytology and have suggested that it may be prudent to consider alternative surveillance, such as colposcopy, in similar high‐risk populations 32,33 . In addition, a large‐scale study of ASC‐US in the Chinese population showed that the rate of hrHPV positivity decreased with increasing age and was highest in women aged <20 years 20 .…”

Section: Discussionmentioning

confidence: 99%

Immediate histologic correlation in women with atypical squamous cells of undetermined significance cytology and positive high‐risk HPV: A retrospective review of 6000 cases in a large academic women's hospital

Zhang

Pradhan

Wang

et al. 2020

Cancer Cytopathology

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Background Previous studies of the histologic correlation in women who have atypical squamous cells of undetermined significance cytology (ASC‐US) and are positive for high‐risk human papillomavirus (hrHPV+) have predominantly utilized the Hybrid Capture 2 (HC2) test, whereas the use of other US Food and Drug Administration (FDA)‐approved methods is relatively limited. Methods Cases of ASC‐US/hrHPV+ that were tested using HC2, Cervista, or Aptima were retrieved, and the immediate histologic correlations were analyzed. Results Overall, 53.9% (n = 3238) of women with ASC‐US/hrHPV+ had immediate histologic correlation. The detection rates for grade 1 cervical intraepithelial neoplasia (CIN1) were similar among the 3 methods (37.1%‐41.8%), while the overall detection rates for grade 2 CIN or higher (CIN2+) were much lower (5.1%‐9.0%). CIN2+ detection rates were similar among different age groups for HC2 testing, whereas for Cervista and Aptima testing, detection rates were highest in the youngest group (age <25 years) and decreased with age. Statistical analyses revealed that the CIN2+ detection rate was significantly higher in younger women who were tested with Cervista. Conclusion These hrHPV testing methods revealed low CIN2+ detection rates in women with ASC‐US/hrHPV+ but demonstrated different patterns when using age‐stratified analyses. The high rate of CIN2+ detection in women aged <25 years by the Cervista and Aptima testing platforms, but not the HC2 platform, suggest that continual investigation of FDA‐approved clinical hrHPV testing—especially large‐scale, long‐term, prospective studies—is needed to evaluate the best options for management of ASC‐US/hrHPV+ in this age group.

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“…The study characteristics are shown in Table 1. Of the 21 studies about smoking as a risk factor for CIN, nine were crosssectional studies that included between 266 and 12,048 respondents [17][18][19][20][21][22][23][24][25]. Three cross-sectional studies had a different study objective than examining the relationship between smoking and CIN [23][24][25].…”

Section: Study Characteristicsmentioning

confidence: 99%

Is smoking an independent risk factor for developing cervical intra-epithelial neoplasia and cervical cancer? A systematic review and meta-analysis

Nagelhout

Ebisch

Hel

et al. 2021

Expert Review of Anticancer Therapy

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Introduction: Cervical cancer is the fourth most common form of cancer among women. Smoking tobacco seems to be a risk factor for the development of cervical intra-epithelial neoplasia (CIN) and cervical cancer, but the exact role of smoking in the process of cervical carcinogenesis is not known. The aim of this study is to investigate the relationship between smoking and the development of CIN and cervical cancer. Areas covered: We searched Embase, Medline, Cochrane Central, Web of Science, and Google Scholar for studies on smoking and CIN and cervical cancer, published between 2009 and 2018. The following were the outcomes: CIN3 alone, CIN2 and CIN3 combined, CIN2+, CIN3+, and cervical cancer alone. We included 49 studies in our review and 45 in our meta-analyses. Expert opinion: Based on the available evidence it can be-cautiously-concluded that smoking increases the risk of cervical abnormalities. However, the high risk of bias indicates that for future studies, it will be important to adjust for relevant predictors, to separate CIN from cervical cancer as outcome measures, and to report research methods in detail.

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

Abstract: 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.

Cited by 6 publications

References 30 publications

Distribution of cervical lesions in young and older women

Distribution of cervical lesions in young and older women

Immediate histologic correlation in women with atypical squamous cells of undetermined significance cytology and positive high‐risk HPV: A retrospective review of 6000 cases in a large academic women's hospital

Is smoking an independent risk factor for developing cervical intra-epithelial neoplasia and cervical cancer? A systematic review and meta-analysis

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