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Atypical Squamous Cells of Undetermined Significance: Human Papillomavirus Testing in Adolescents

Lori A. Boardman, MD, ScM^*, Cara Stanko, MD^*, Sherry Weitzen, PhD^* and C. James Sung, MD

From the *Departments of Obstetrics and Gynecology and Pathology, Women and Infants’ Hospital of Rhode Island, Brown Medical School, Providence, Rhode Island.

OBJECTIVE: To estimate the age-stratified prevalence of oncogenic human papillomavirus (HPV) infection and to evaluate risk factors for HPV acquisition among women with atypical squamous cells of undetermined significance (ASC-US).

METHODS: This was a chart review of all women with ASC-US smears who underwent oncogenic HPV testing between July 2002 and February 2004. To be eligible, HPV DNA results had to be available. Data extracted from charts included demographic information as well as certain patient characteristics historically associated with HPV acquisition or carriage.

RESULTS: Of 527 eligible women with ASC-US, 357 (68%, 95% confidence interval [CI] 64–72%) tested positive for oncogenic HPV. As compared with women who tested negative, this population was significantly younger and less likely to be married. When stratified by age, 77% of the women aged younger than 20 years were positive for high-risk subtypes, compared with 58% of women aged older than 25 years (P < .01). In the multivariate analysis, young age (relative risk [RR] 1.30, 95% CI 1.14.–1.49), current smoking (RR 1.14, 95% CI 1.03–1.25) and a history of chlamydial infection (RR 1.20, 95% CI 1.09–1.32) were associated with an increased likelihood of HPV infection, while oral contraceptive use (RR 0.86, 95% CI 0.72–1.03) had a marginal protective effect. The protective effect of oral contraceptives was most pronounced among adolescent women (RR 0.57, 95% CI 0.31–1.03).

CONCLUSION: Given that the rate of oncogenic HPV infection approached 80% in our population of adolescent women with ASC-US, the usefulness of HPV testing in this age group requires further investigation.

LEVEL OF EVIDENCE: II-3

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