Abnormal Pap Smears - Pap smear screening in an urban STD clinic: Yield of screening and predictors of abnormalities.
Shlay JC, McGill WL, Masloboeva HA, Douglas JM Jr.
Department of Public Health, Denver Disease Control Service, Denver Health Medical Center, Colorado, USA.
BACKGROUND: Pap smear screening studies in STD clinics have reported high rates of squamous intraepithelial lesions (SIL); however, there are limited data on levels of unsatisfactory smears of characteristics associated with cytologic abnormalities. GOAL: To assess the yield to Pap smear screening in an STD clinic and to evaluate the rates of and risk factors for atypia, low-grade SIL (LSIL), and high-grade SIL (HSIL).
STUDY DESIGN: A chart review of the clinic records of women undergoing Pap smear screening between 1991 and 1994 was conducted. Results were assessed from two different screening protocols, the first using a Dacron swab to obtain the endocervical sample and the second using a cytobrush.
RESULTS: Of 2034 Pap smears, 1313 (64.6%) were negative, 202 (9.9%) were unsatisfactory, 257 (12.6%) were atypical, 211 (10.4%) had LSIL, and 51 (2.5%) had HSIL. With the change to the cytobrush protocol, the rate of unsatisfactory smears decreased from 14.4% to 3% (p < 0.001), atypia increased from 10% to 16.7% (p < 0.001), and HSIL rose from 1.7% to 3.7% (p < 0.001). By multivariate analysis, atypia was associated with genital warts (odds ratio (OR) 1.53, 95% confidence interval (CI): 1.16-2.02); LSIL with younger age (p < 0.001, for trend), black race (OR 1.51, 95% CI: 1.08-2.10), genital warts (OR 1.81, 95% CI: 1.33-2.47), and an abnormal appearance of the cervix on examination (OR 2.49, 95% CI: 1.85-3.35); and HSIL with a previous abnormal Pap smear (OR 2.48, 95% CI: 1.08-2.10). Overall, abnormality rates were significantly higher in adolescents (35.5%) than older women (21.7%) (p < 0.01).
CONCLUSIONS: Obtaining satisfactory Pap smears among women undergoing screening in an STD clinic is feasible and cytologic abnormalities are common. These results continue to support the need for Pap smear screening in STD clinics, but the high rates in adolescents, a group in whom the natural history of cytologic abnormalities has not been well-defined, raise questions about the need to develop age-appropriate screening and management strategies.
Credit: PubMed
: Sex Transm Dis 1998 Oct;25(9):468-75
Abnormal Pap Smears - Natural history of cervicovaginal papillomavirus infection in young women.
Ho GY, Bierman R, Beardsley L, Chang CJ, Burk RD.
Department of Epidemiology, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
BACKGROUND: Genital human papillomavirus (HPV) infection is highly prevalent in sexually active young women. However, precise risk factors for HPV infection and its incidence and duration are not well known.
METHODS: We followed 608 college women at six-month intervals for three years. At each visit, we collected information about lifestyle and sexual behavior and obtained cervicovaginal-lavage samples for the detection of HPV DNA by polymerase chain reaction and Southern blot hybridization. Pap smears were obtained annually.
RESULTS: The cumulative 36-month incidence of HPV infection was 43 percent (95 percent confidence interval, 36 to 49 percent). An increased risk of HPV infection was significantly associated with younger age, Hispanic ethnicity, black race, an increased number of vaginal-sex partners, high frequencies of vaginal sex and alcohol consumption, anal sex, and certain characteristics of partners (regular partners having an increased number of lifetime partners and not being in school). The median duration of new infections was 8 months (95 percent confidence interval, 7 to 10 months). The persistence of HPV for > or =6 months was related to older age, types of HPV associated with cervical cancer, and infection with multiple types of HPV but not with smoking. The risk of an abnormal Pap smear increased with persistent HPV infection, particularly with high-risk types (relative risk, 37.2; 95 percent confidence interval, 14.6 to 94.8).
CONCLUSIONS: The incidence of HPV infection in sexually active young college women is high. The short duration of most HPV infections in these women suggests that the associated cervical dysplasia should be managed conservatively.
Credit: PubMed
: N Engl J Med 1998 Feb 12;338(7):423-8
Abnormal Pap Smears - History of genital warts in 10,838 women 20 to 29 years of age from the general population. Risk factors and association with Papanicolaou smear history.
Munk C, Svare EI, Poll P, Bock JE, Kjaer SK.
Danish Cancer Society, Division for Cancer Epidemiology, Copenhagen, Denmark.
BACKGROUND AND OBJECTIVES: The most important risk factor for cervical neoplasia is genital infection with certain types of human papillomavirus (HPV). Genital warts (GW) are an easily recognizable condition caused by HPV. Although only a fraction of HPV infections are clinical, a history of ever having had GW could serve as a marker for exposure to HPV.
GOALS: To study the risk factors for ever having had GW. The association of GW with abnormal Papanicolaou (Pap) smear and relation to cervical neoplasia is also discussed.
STUDY DESIGN: A case-control study among 10,838 women aged 20 to 29 years and reporting at least one lifetime sexual partner. The women were participants in a prospective cohort study on the relationship between HPV and cervical neoplasia in Copenhagen, Denmark. Data were obtained by means of personal interviews using structured questionnaires.
RESULTS: In all, 1,820 women (17%) reported ever having had GW. The most important risk factor was the number of lifetime of sexual partners (adjusted odds ratio 5.2; 95% confidence interval: 3.4-8.0) for at least 40 partners vs. 1 to 2 partners). The number of regular partners, sexually active years, a history of chlamydial infection, and smoking were also associated with the risk of ever having had GW. Women who had had GW were 1.9 times more likely than other women to report an abnormal Pap smear.
CONCLUSIONS: The study confirms the sexual transmission of the infection. There is also good concordance between risk factors for ever having had GW and cervical neoplasia. A close relationship between having had GW and an abnormal Pap smear was observed.
Credit: PubMed
: Sex Transm Dis 1997 Nov;24(10):567-72
Abnormal Pap Smears - ThinPrep Pap test more sensitive than conventional Pap smear
Source: Reuters News
Publish Date: 01/24/2003
NEW YORK (Reuters Health) - The ThinPrep Pap test (Cytyc, Boxborough, Massachusetts) is more sensitive in detecting cervical and endometrial adenocarcinomas than is the conventional Pap smear, according to a report in the December 25th issue of Cancer.
Dr. Raheela Ashfaq and colleagues from the University of Texas Southwestern Medical Center, Dallas, evaluated women with atypical glandular cells of undetermined significance (AGCUS) or adenocarcinomas diagnosed between 1998 and 2000 using the ThinPrep method. The control group included women who underwent conventional smears obtained between 1996 to 1998. Histological follow-up was performed for all patients.
Of 112,058 ThinPrep Pap tests, 186 (0.17%) were found to be AGCUS/adenocarcinomas, the researchers report. Of the 83,464 conventional smears, 77 (0.09%) were interpreted as AGCUS/adenocarcinomas.
The overall sensitivity in detecting cervical and endometrial adenocarcinomas was higher with the ThinPrep Pap test (72%) than with the conventional Pap smear (41.5%, p < 0.001).
"We believe that the introduction of the ThinPrep Pap test in our laboratory has resulted in a significant improvement in the detection of glandular lesions," the investigators conclude. "Our findings suggest that this system can facilitate a more directed approach to the evaluation and treatment of cervical and endometrial adenocarcinomas."
Copyright c 2002 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon.
Credit: Cancer Source
Abnormal Pap Smears - Links
Abnormal PAP Smears - A Gynecologist's Second Opinion
- Abnormal PAP Smears, HPV, Cervical Dysplasia and Cancer. The following questions
and answers can be found in our book: ABOUT ABNORMAL PAP SMEARS.
Abnormal Pap Smears And A Word About Douching
- Abnormal Pap Smears And A Word About Douching. Secondly, there is no such thing
as a "slightly abnormal" pap. Pap smears are screens, not diagnostic tests.
Abnormal pap smear: cervical dysplasia, and treatment
- Although cervical cancer is the first thing that may comes to mind, most of the time an abnormal pap smear indicates a minor Classification of Pap smears.
Abnormal Pap Smear: hpv human papillomavirus, cervical dysplasia
- Our book, Abnormal Pap Smears: What Every Woman Needs to Know, is written for women like you. Abnormal Pap Smears: What Every Woman Needs to Know.
Abnormal Pap Smears - Reading Your Results
- Abnormal Pap Smears - Reading Your Results. The Bethesda System The Betheseda is the third major reworking of the the Pap smear.
Abnormal Pap Smears - Womens Health
- Abnormal Pap smears do not mean cancer; diagnosis and treatment options, from your About.com Guide. Advertisement. Abnormal Pap Smears.
Pap Smears: When Yours is Slightly Abnormal
- Return to Index, Information from Your Family Doctor. Pap Smears:
When Yours is Slightly Abnormal. What did my Pap smear show?
UCLA-the Ashe Center - Abnormal Pap Smears Handout
- Abnormal pap smears. Colposcopy. The term "colposcopy" describes a specialized method of examining the vagina and the cervix.
UI Study On Mildly Abnormal Pap Smears Seeks Participants
- University of Iowa News Release. April 3, 2003. UI Study On Mildly
Abnormal Pap Smears Seeks Participants. Women age 18 and older.
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