title: The significance of atypical cervical cytology in an older population.
abstract: To ascertain the significance of squamous atypia encountered during routine Papanicolaou smear screening in an older population, we reviewed 115 consecutive patients over age 50 seen during a 3-year period. Evaluation included repeating the smear and performing colposcopy in all patients. Colposcopically directed biopsy and endocervical curettage were performed when appropriate. Sixty-seven patients (58.3%) had atrophy, 43 (37.4%) were normal, two (1.7%) had cervical intraepithelial neoplasia grade 1, two (1.7%) had cervical intraepithelial neoplasia grade 2, and one (0.9%) had human papillomavirus (HPV) infection. There was a strong association between squamous atypia and estrogen deficiency. With the correction of the estrogen deficiency, the squamous atypia reverted to normal in a statistically significant percentage of patients. A Papanicolaou smear report of squamous atypia in women over age 50 should not be considered normal; further evaluation is required. The incidence of cervical or vaginal intraepithelial neoplasia and HPV infection is much lower than reported in studies involving younger patients.
authors.affiliation: Milton S. Hershey Medical Center, Pennsylvania State University, Hershey.
authors.forename: P F
authors.initials: PF
authors.lastname: Kaminski
authors.forename: J I
authors.initials: JI
authors.lastname: Sorosky
authors.forename: J B
authors.initials: JB
authors.lastname: Wheelock
authors.forename: C W
authors.initials: CW
authors.lastname: Stevens
mesh_terms: D000368:Aged; D002278:Carcinoma in Situ / Q000453:epidemiology*; D003127:Colposcopy; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D008922:Mississippi; D065006:Papanicolaou Test; D027383:Papillomaviridae; D011446:Prospective Studies; D014412:Tumor Virus Infections / Q000453:epidemiology*; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology*; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology*; D014626:Vaginal Smears