Anna-Barbara Moscicki1, Yifei Ma, Charles Wibbelsman, Adaleen Powers, Teresa M Darragh, Sepideh Farhat, Ruth Shaber, Stephen Shiboski. 1. From the Department of Pediatrics, School of Medicine, University of California, San Francisco; Teenage Clinic, Kaiser Permanente San Francisco; Department of Pathology, University of California, San Francisco; Women's Health Research Institute, Kaiser Permanente Daly City; and Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
Abstract
OBJECTIVE: To estimate the risks of cervical intraepithelial neoplasia (CIN) 3 among girls and women aged 13 to 24 years who were referred for abnormal cytology while receiving care in a large health maintenance organization. METHODS: At the time of referral, patients had a colposcopic examination and biopsy if needed. Histology was sent to a centralized laboratory. Patients were interviewed for risk behaviors. Data analysis included multinomial logistic regression analysis to compare three groups: CIN 3 to CIN 1 or less, CIN 3 to CIN 2, and CIN 2 to CIN 1 or benign. RESULTS: Cervical intraepithelial neoplasia-3 was found in 6.6% (95% confidence interval [CI] 4.6-8.6%) of the 622 girls and women referred and no cancers were detected. Risk for CIN 3 compared to CIN 1 or less included human papillomavirus 16 or 18 (odds ratio [OR] 30.93, 95% CI 6.95-137.65), high-risk, non-16/18 human papillomavirus (OR 6.3, 95% CI 1.3-29.4), and time on oral contraceptives (OR 1.36 per year of use, 95% CI 1.08-1.71). CONCLUSION: Our data support conservative care for adolescents and young women with abnormal cytology since CIN 3 was rare and cervical cancer was never found. Human papillomavirus 16 or 18 was strongly associated with for CIN 3, and testing for these types may be warranted for triage of abnormal cytology in this age group. LEVEL OF EVIDENCE: II.
OBJECTIVE: To estimate the risks of cervical intraepithelial neoplasia (CIN) 3 among girls and women aged 13 to 24 years who were referred for abnormal cytology while receiving care in a large health maintenance organization. METHODS: At the time of referral, patients had a colposcopic examination and biopsy if needed. Histology was sent to a centralized laboratory. Patients were interviewed for risk behaviors. Data analysis included multinomial logistic regression analysis to compare three groups: CIN 3 to CIN 1 or less, CIN 3 to CIN 2, and CIN 2 to CIN 1 or benign. RESULTS:Cervical intraepithelial neoplasia-3 was found in 6.6% (95% confidence interval [CI] 4.6-8.6%) of the 622 girls and women referred and no cancers were detected. Risk for CIN 3 compared to CIN 1 or less included human papillomavirus 16 or 18 (odds ratio [OR] 30.93, 95% CI 6.95-137.65), high-risk, non-16/18 human papillomavirus (OR 6.3, 95% CI 1.3-29.4), and time on oral contraceptives (OR 1.36 per year of use, 95% CI 1.08-1.71). CONCLUSION: Our data support conservative care for adolescents and young women with abnormal cytology since CIN 3 was rare and cervical cancer was never found. Human papillomavirus 16 or 18 was strongly associated with for CIN 3, and testing for these types may be warranted for triage of abnormal cytology in this age group. LEVEL OF EVIDENCE: II.
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