Lessons from practice: risk of CIN 3 or cancer associated with an LSIL or HPV-positive ASC-US screening result in women aged 21 to 24.
OBJECTIVE
To characterize the risks of cervical intraepithelial neoplasia 3 (CIN 3) and cancer in women aged 21 to 24 with human papillomavirus (HPV)-positive atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL) screening results in routine clinical practice.


METHODS
Quality assurance databases containing records of screening test and histologic findings from the Regional Laboratory of the Northern California Kaiser Permanente Medical Care Program were reviewed. Numbers of LSIL and HPV-positive ASC-US results and associated cancers and CIN 3 in women aged 21 to 24 during 2003 to 2007 were tabulated, and the corresponding risks were calculated overall and by year of age.


RESULTS
During the 5-year period from 2003 to 2007, 1,620 HPV-positive ASC-US and 2,175 LSIL were diagnosed in women aged 21 to 24, for which corresponding histologic finding is available. No invasive cancers were detected in association with LSIL and HPV-positive ASC-US screening results in this age group during this period. The risk of cancer was therefore 0% (95% CI = 0.00%-0.10%). The risk of CIN 3 associated with an HPV-positive ASC-US was 2.90% (95% CI = 2.14%-3.84%), with LSIL was 2.44% (95% CI = 1.83%-3.18%), and, for the 2 combined, the risk was 2.64% (95% CI = 2.15%-3.20%).


CONCLUSIONS
The risk of CIN 3 and cancer is low enough that management of women aged 21 to 24 with ASC-US and LSIL smears without immediate colposcopy should be considered, as is currently recommended for women aged 20 and younger.
Moore
Gaea
G
University of California Davis, Sacramento, The Permanente Medical Group, Oakland, CA, USA.
Fetterman
Barbara
B
Cox
J Thomas
JT
Poitras
Nancy
N
Lorey
Thomas
T
Kinney
Walter
W
Castle
Philip E
PE
D002140:California / Q000453:epidemiology; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D030361:Papillomavirus Infections / Q000150:complications*; D012307:Risk Factors; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology*; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology*; D055815:Young Adult