Pap Smear Abnormalities in Adolescents and Young Women
Keywords:Adolescent, Uterine Cervical Neoplasms, Cervical Intraepithelial Neoplasia, Cervical Cancer Prevention
Introduction: Adolescence is a period in the life of a woman characterized by significant physical and psychological changes. In various places in the world it is also the period in which sexual activity usually begins. Sexual activity has been occurring increasingly earlier in adolescents.
Objective: To evaluate the prevalence of Pap smear abnormalities in adolescents and young women (MJA) compared to adult women (MA). Methods: Cross-sectional study of cervical uterine cytology obtained from women in Santo AndrÃ© (SP, Brazil) between January 2009 and December 2011, comparing the cytological results between MJA (age: 14-24 years) and MA (age: 25 years or over). Results: 92,118 exams evaluated; 76,752 in the MA group and 15,366 in the MJA group. Of the total, 89,723 were normal and 2,395 abnormal (1,278 [53.4%] corresponded to atypical squamous cells of undetermined significance [ASCUS], 900 [37.6%] to low-grade squamous intraepithelial lesion [LSIL] and 217 [9.1%] to high-grade squamous intraepithelial lesion [HSIL]). There were 510 (3.3%) abnormal tests in the MJA group and 1,885 (2.5%) in the MA group, of which 217 (42.5%) and 1061 (56.3%), respectively, were classified as ASCUS, 280 (54.9%) and 620 (32.9%), respectively, as LSIL, and 13 (2.5%) and 204 (10.8%), respectively, as HSIL. Conclusion: The most frequent abnormality in the MJA group was LSIL and in the MA group was ASCUS. HSIL was 4 times more frequent in adult women in comparison to young women and adolescents.
-Centro Brasileiro de AnÃ¡lise e Planejamento. Pesquisa Nacional de Demografia e SaÃºde da CrianÃ§a e da Mulher â€“ PNDS 2006. BrasÃlia: MinistÃ©rio da SaÃºde, 2009; 298 pp.
-MinistÃ©rio da SaÃºde. Pesquisa Nacional de SaÃºde do Escolar. BrasÃlia: MinistÃ©rio da SaÃºde, 2012, 251pp.
-Instituto Nacional de CÃ¢ncer. HPV e CÃ¢ncer. DisponÃvel em: http://mortalidade.inca.gov.br. Acesso em: 27/10/2014.
-Derchain SFM, Pinto Neto AM, Oliveira RLC, Santos CL, Pinto e Silva JLC. InfecÃ§Ã£o por papilomavÃrus humano e neoplasia intraepitelial cervical em adolescentes. J Bras Ginecol. 1991;101:499-503.
-Morrison EA, Ho GY, Vermud ST et al. Human papillomavirus infection and other risk factors for cervical neoplasia: a case control study. Int J Cancer. 1991;49:6-13.
-Kahn JA, Goodmann E, Huang B, Slap GB, Emano SJ. Predictors of Papanicolaou smear in a hospital-based adolescent and young adult clinic. Obstet. Gynecol. 2003;101(2):490-9.
-Instituto Nacional de CÃ¢ncer. Estimativa de 2014 de incidÃªncia de cÃ¢ncer no Brasil. DisponÃvel em: http://www.inca.gov.br/estimativa/2014/sintese-de-resultados-comentÃ¡rios.asp. Acesso em: 17/08/2014.
-LÃ¼dicke F, Stalberg A, Vassilakos P, Major AL, Campana A. High- and intermediate-risk human papillomavirus infection in sexually active adolescent females. J Pediatric Adolesc Gynecol. 2001;14(4):171-4.
-Monteiro DLM. A cÃ©rvice uterina na adolescÃªncia: estudo da prevalÃªncia e fatores associados ao cÃ¢ncer de colo uterino e suas lesÃµes precursoras em populaÃ§Ã£o de adolescentes no Rio de Janeiro. DissertaÃ§Ã£o de Mestrado. Rio de Janeiro: FIOCRUZ, 2004.
- Instituto Nacional de CÃ¢ncer. Diretrizes brasileiras para o rastreamento do cÃ¢ncer do colo do Ãºtero. Rio de Janeiro: Instituto Nacional de CÃ¢ncer e MinistÃ©rio da SaÃºde, 2011, 104 pp.
-Instituto Brasileiro de Geografia e EstatÃstica (IBGE). DisponÃvel em: http://www.cidades.ibge.gov.br/xtras/home.php. Acesso em 28/10/2014.
-Instituto Brasileiro de Geografia e EstatÃstica (IBGE). DisponÃvel em: http://cod.ibge.gov.br/232PM. Acesso em 28/07/2014.
-International Agency of Research on Cancer - IARC. Working Group on Evaluation of Cervical Cancer Screening Programmes. Screening for squamous cervical cancer: duration of low risk after negative results of cervical cytology and its implication for screening policies. BMJ. 1986;293:659-64.
-Vale DB, Westin MC, Zeferino LC. High-grade squamous intraepithelial lesion in women aged <30 years has a prevalence pattern resembling low-grade squamous intraepithelial lesion. Cancer Cytopathol. 2013;121(10):576-81.
-Nascimento MI, Pires ES, GIL DQ et al. CaracterÃsticas de um grupo de adolescentes com suspeita de neoplasia intraepitelial cervical. Rev Bras Ginecol Obstet. 2005;27(10):619-26.
-Mello ES. Rastreamento do cÃ¢ncer do colo uterino: desafios e recomendaÃ§Ãµes. Onco& 2012; novembro/dezembro:30-35. DisponÃvel em: http://www.revistaonco.com.br. Acesso: 20/12/2014.
-Insinga RP, Glass AG, Rush BB. Diagnoses and outcomes in cervical cancer screening: a populationbased study. Am J Obstet Gynecol. 2004; 191(1):105-13.
-Solomon D, Nayar R. Sistema Bethesda para Citologia Cervicovaginal. Rio de Janeiro: Revinter, 2005, 192 pp.
-Nascimento MI, Pires ES, Gil DQ et al. CaracterÃsticas de um grupo de adolescentes com suspeita de neoplasia intra-epitelial cervical. Rev Bras Ginecol Obstet. 2005;27(10):619-626.
-Kyrgiou M, Koliopoulos G, Martin-Hirsch P et al. Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis. Lancet 2006;367(9509):489-98.
-Ortoft G, Henriksen T, Hansen E, Petersen L. After conisation of the cervix, the perinatal mortality as a result of preterm delivery increases in subsequent pregnancy. BJOG 2010;117(3):258-67.
-Cirino FMSB, Nichiata LYI, Borges ALV. Conhecimento, atitude e prÃ¡ticas na prevenÃ§Ã£o do cÃ¢ncer de colo uterino e HPV em adolescentes. Esc Anna Nery Rev Enferm. 2010;14(1):126-34. DisponÃvel em: http://www.revistaenfermagem.eean.edu.br. Acesso em: 20/12/2014.
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