Cytologic screening is an important diagnostic tool to detect precancerous and cancerous lesions of the uterine cervix. Cervical intraepithelial neoplasia (CIN) represents a continuum of neoplastic alterations, from mild dysplasia to carcinoma in situ. Our high incidence of 32/1,000 adolescent girls with abnormal cervical cytology, suggestive of CIN, supports studies showing that major cervical pathology does exist in this age group. The importance of this problem, previous experiences, reliability of screening, management, and associated risk factors are reviewed. We advocate that the sexually active older adolescent, 18 to 21, have PAP smears at least yearly. It is also our feeling that sexually active adolescents under 18 should have annual PAP smears, even though our studies revealed a paucity of significantly abnormal findings in this age group.
Get full access to this article
View all access options for this article.
References
1.
Ferguson J.: Positive cancer smears in teenage girls. JAMA178:365, 1961
2.
Christopherson W.: The risk of cervical cancer in teenaged girls . JAMA194:176, 1965
3.
Kaufman R., Burmeister R., Spjut H.: Cervical cytology in the teenage patient. Am J Obstet Gynecol108:515, 1970
4.
Wallace D., Slankard J.: Teenage cervical carcinoma in situ. Obstet Gynecol41:697, 1973
5.
Fields C., Restivo R., Brown M.: Experience in mass Papanicolaou screening and cytologic observations of teenage girls. Am J Obstet Gynecol124:730, 1976
6.
Feldman M., Linzey E., Srebnik E., Kent D., et al: Abnormal cervical cytology in the teenager—a continuing problem. Am J Obstet Gynecol126: 418, 1976
7.
Hein K., Schreiber K., Cohen M., Koss L.: Cervical cytology: the need for screening in the sexually active adolescent . J Pediatr91:123, 1977
8.
Koss L.: Diagnostic Cytology and Its Histopathologic Basis, Second Edition. Philadelphia, JB Lippincott , 1968, p 170
9.
Richart R.: Colpomicroscopic studies of the distribution of dysplasia and carcinoma in situ on the exposed portion of the human uterine cervix. Cancer18:950, 1965
10.
Richart R.: Influence of diagnostic and therapeutic procedures on the distribution of cervical intraepithelial neoplasia. Cancer19:1635, 1966
11.
Nelson J., Averette H., Richart R.: Detection, diagnostic evaluation and treatment of dysplasia, carcinoma in situ and early invasive cervical carcinoma. CA—A Cancer Journal for Clinicians29:174, 1979
12.
Homesley H. : Evaluation of the abnormal PAP smear. Am Fam Physician16:190, 1977
13.
Stafl A., Mattingly R.: Coloscopic diagnosis of cervical neoplasia. Obstet Gynecol41:168, 1973
14.
Stern E., Neely P.: Carcinoma and dysplasia of the cervix: a comparison of rates for new and returning populations. Acta Cytol7:357, 1963
15.
Varga A.: The relationship of cervical dysplasia to in situ and invasive carcinoma of the cervix. Am J Obstet Gynecol95:759, 1966
16.
Homesley H.: op cit, p 190
17.
Cruikshank D., Kaminsky D., Ejbladh L.Colposcopic evaluation of cervical intraepithelial neoplasia. J Reprod Med17:327, 1976
18.
Feldman M., Kent D., Pinnington R.: Intraepithelial neoplasia of the uterine cervix in the teenager. Cancer41:1405, 1978
19.
Koss L.: op cit, p 226
20.
Rothbard MJ , Greenberg H.: Gynecologic health problems in the socially abused adolescent female. NY State J Med76:1483, 1976
21.
Skinner G., Whitney J., Hartley C.: Prevalence of type-specific antibody against type 1 and type 2 herpes simplex virus in women with abnormal cervical cytology; evidence towards prepubertal vaccination of seronegative female subjects. Arch Virol54:211, 1977
22.
American Cancer Society: Guidelines for the cancer-related checkup. CA—A Cancer Journal for Clinicians30:215, 1980
23.
Katchadourian H.: Adolescent sexuality. Pediatr Clin North Am27:17, 1980
24.
Richart RM: The patient with an abnormal PAP smear—screening techniques and management . N Engl J Med302:332, 1980
25.
American Academy of Pediatrics.Policy statement. Pediatrics49:463, 1972
