Mild and moderate dyskaryosis: can women be selected for colposcopy on the basis of social criteria?

OBJECTIVE--To describe the distribution of cervical intraepithelial neoplasia grades among women with mild and moderate dyskaryosis after a single cervical smear and to determine whether social criteria could help identify women who are at increased risk of grade II or III disease. DESIGN--Cross sectional analysis within a randomised prospective study. Subjects had a repeat smear, a colposcopic examination, and an excision biopsy of the transformation zone. In addition, women were asked to complete a social questionnaire. SETTING--Colposcopy clinic, Aberdeen. SUBJECTS--228 women with a single smear test showing mild or moderate dyskaryosis. MAIN OUTCOME MEASURES--Histology, age, sexual and contraceptive history, cigarette smoking. RESULTS--159 (70%) women had cervical intraepithelial neoplasia grades II or III. Among current smokers the prevalence of grade II and III disease was higher in women who smoked greater than or equal to 20 cigarettes a day (84%) than among those who smoked less (66%; p less than 0.04). Women with more than one sexual partner also had a higher prevalence (75%) than women with only one partner (50%; p = 0.0028). Use of oral contraceptives and younger age were not significantly associated. The prevalence of grade II or III disease was up to 66% in the lower risk groups. CONCLUSIONS--Because of the high prevalence of cervical intraepithelial neoplasia grades II and III in both the high and the low risk groups social factors are not useful for selecting women with mild or moderate dyskaryosis for either early referral to colposcopy or cytological surveillance.

目的——描述单次宫颈涂片显示轻度和中度核异质的女性中宫颈上皮内瘤变分级的分布情况，并确定社会标准是否有助于识别患II级或III级疾病风险增加的女性。 设计——一项随机前瞻性研究中的横断面分析。受试者接受重复涂片、阴道镜检查以及转化区切除活检。此外，要求女性填写一份社会调查问卷。 地点——阿伯丁阴道镜诊所。 受试者——228名单次涂片检查显示轻度或中度核异质的女性。 主要观察指标——组织学、年龄、性及避孕史、吸烟情况。 结果——159名（70%）女性患有II级或III级宫颈上皮内瘤变。在当前吸烟者中，每天吸烟≥20支的女性患II级和III级疾病的患病率（84%）高于吸烟较少者（66%；P＜0.04）。有多于一个性伴侣的女性患病率（75%）也高于只有一个性伴侣的女性（50%；P = 0.0028）。口服避孕药的使用和较年轻的年龄无显著相关性。低风险组中II级或III级疾病的患病率高达66%。 结论——由于高风险组和低风险组中II级和III级宫颈上皮内瘤变的患病率都很高，社会因素对于选择轻度或中度核异质的女性进行早期阴道镜转诊或细胞学监测并无帮助。