Abstract
Study Objective
To determine the prevalence of cervical dysplasia and adherence to recommendations
for referral/follow-up in a group of adolescent girls undergoing routine reproductive
health care in a primary care setting.
Design
Retrospective review of all screening Papanicolaou (Pap) smears performed between
12/99 and 12/05.
Setting
An urban academic adolescent medicine practice in New York City.
Participants
824 sexually active adolescent girls.
Main Outcomes
Cytology and cervical biopsy results and adherence to follow-up and colposcopy recommendations.
Results
Among 824 adolescents ages 12–21 years (mean = 17) who underwent 1 to 6 screening
Paps, 81% (n = 666) had normal Pap smears only and 19% (n = 158) had at least one
abnormal Pap. Of the 1214 screening Pap smears reviewed, only one was suggestive of
a high grade lesion, 85 (7%) revealed atypical squamous cells of undetermined significance
(ASCUS), 81 (6.6%) showed low-grade squamous intraepithelial lesions (LGSIL), and
the rest were normal. Fifteen percent of patients (n = 123) were referred for at least
one colposcopy; only 72% (n = 88) complied. Biopsy identified 5 high-grade lesions;
3 patients required cervical Loop Electrosurgical Excision Procedures: Despite appropriate referrals and access to services, 32% of patients with ASCUS
and 28% of patients with LGSIL lacked evidence of either follow-up Pap or colposcopy
by the time of last review.
Conclusions
High-grade lesions were rare in our sample, supporting new guidelines for less colposcopy
in this age group. Although many adolescents were followed within primary care, achieving
appropriate follow-up for those with cervical dysplasia was challenging and often
unsuccessful.
Key Words
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Article info
Publication history
Published online: April 13, 2009
Identification
Copyright
© 2009 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
