A 6-year experience with Pap smears in an urban adolescent practice: the scope and burden of abnormalities.
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.


METHODS
Retrospective review of all screening Papanicolaou (Pap) smears performed between 12/99 and 12/05.


METHODS
An urban academic adolescent medicine practice in New York City.


METHODS
824 sexually active adolescent girls.


RESULTS
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.
Soren
Karen
K
Departments of Pediatrics and Obstetrics/Gynecology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA. Ks23@columbia.edu
Kharbanda
Elyse Olshen
EO
Chen
Shaofu
S
Westhoff
Carolyn
C
D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D009519:New York City / Q000453:epidemiology; D065006:Papanicolaou Test; D010349:Patient Compliance; D015995:Prevalence; D014505:Urban Population; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000453:epidemiology*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D014626:Vaginal Smears; D055815:Young Adult