Predictors of co-incidental CIN II/III amongst a cohort of women with CIN I detected by a screening Pap test.
Approximately 20-40% of lesions interpreted by a screening Pap test as CIN I and subsequently examined by colposcopy include a co-incidental CIN II/III. Since the HPV profiles of CIN I and CIN II/III differ, HPV typing may predict these co-incidental higher grade lesions. Based on both the colposcopic impression and repeat Pap test, 537 women referred for examination of CIN I as classified by a screening Pap test were triaged into group A (</= CIN I) or group B (>/= CIN II). Clinical, demographic, reproductive, and risk factor data was collected by questionnaire and HPV typing of cervical scrapes was done by PCR. Group A included 342 (63.7%) women and group B 195 (36.3%). Group B women more frequently were current cigarette smokers (p<0.001) and had a high school or lesser level of education (p=0.04). HPV positivity amongst younger group B women (</= 21 years) and a history of current/occasional cigarette smoking in those 22 years and older were significant predictors of triaged, co-incidental CIN II/III (p<0.001). This age restriction will limit the adoption of HPV testing as an universal, adjunctive test for the identification of CIN II/III amongst CIN I lesions detected by a screening Pap test. A greater health advantage may be gained by increasing women's awareness of the risks, including that of cervical cancer associated with cigarette smoking.
Duggan
M A
MA
Department of Pathology, Foothills Hospital and the University of Calgary, Alberta, Canada.
McGregor
S E
SE
Stuart
G C
GC
Morris
S
S
Chang-Poon
V
V
Schepansky
A
A
Honore
L
L
D000328:Adult; D015331:Cohort Studies; D003127:Colposcopy; D005260:Female; D006801:Humans; D012307:Risk Factors; D018709:Statistics, Nonparametric; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000473:pathology*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology / Q000473:pathology*