Lifetime prevalence of cervical neoplasia in addicted and medical patients

The prevalence and timing of cervical dysplasia among substance use disorder (SUD) patients is not well studied.

A cross-sectional pilot survey was undertaken among our primary practice female medical and SUD patients by patient recall of cervical screening history.

One hundred and fifty-three SUD patients were compared with 77 general medical patients younger than 45 years old. The substances abused in this population have previously been described. There was no difference in the mean number of Pap smears (mean +/- SEM 6.30 +/- 0.55 vs 5.68 +/- 0.70, respectively) or the time since last screening (2.93 +/- 0.29 vs 1.60 +/- 0.26 years). Limiting the analysis to patients younger than 45 years effectively controlled for the difference in ages between SUD and medical patients (29.94 +/- 0.52 and 30.21 +/- 1.04 years). Significant differences in cytological abnormalities (OR = 5.88, CI 1.92-23.92; P = 0.0005), cervical intraepithelial neoplasia (CIN) (OR = 14.4, CI 2.20-602.92, P = 0.001) and high-grade CIN-cancer (P = 0.002) were noted. When diagnoses were scored and charted, the trend of the lines of best fit in the two groups was significantly different (P < 0.00001). There were five and two cancers noted in the two groups. There were two and ten hysterectomies performed in the two groups which were for two and one indications of cancer, respectively. In the addicted group invasive cancer was diagnosed at 23-, 23-, 34- and 37-years olds.

SUD patients have a very high rate of abnormalities on cervical screening including precancerous lesions and these changes occurred at significantly younger ages. The possibility of some form of cancer promotion merits further investigation.