Cervical cytology: the need for routine screening in the sexually active adolescent

Pelvic examinations, including a Papanicolaou smear of the uterine cervix, were performed on 403 asymptomatic, sexually active adolescent girls aged from 12 to 16 years who were in a youth detention center in New York City. The smears were negative for precancerous abnormalities in 389 girls, but 168 of these had evidence of inflammation or nonspecific atypia. In the remaining 14 smears there was cytologic evidence of early precancerous changes (low-grade cervical intraepithelial neoplasia). The prevalence rate for early neoplastic changes was 35/1,000, far higher than previously reported. Further evaluation of three of these girls, by colposcopy and biopsy, revealed precancerous epithelial abnormalities of varying degrees of severity in two of them. Since all patients screened were sexually active and were asyptomatic, no clinical feature distinguished the 389 with negative cytology from the 14 with intraepithelial neoplasia. Five of the patients with precancerous cellular abnormalities had histories of sexual activity of less than two years. The data suggest that cervical cytologic screening should be incorporated into the routine examination of sexually active female adolescents.