Cervical dysplasia among women over 35 years of age

The marked reduction in cervical cancer deaths in the United States is due to early identification of high-grade cervical intraepithelial neoplasia (CIN) 2/3, which is generally accepted as the histologic precursor for development of cervical cancer. Some investigators believe that the risk of CIN 2/3 among women between 35 and 50 years of age is less than among younger women, but this is unproven. In postmenopausal women presenting with cytologic abnormalities, there are conflicting data on the risk of dysplasia compared with younger women; some investigators reported increased risk, and others have found a similar or decreased risk. This retrospective study examined cytologic and histopathologic features among two groups of women with cervical dysplasia who presented to a university referral colposcopy center between 2001 and 2005: premenopausal women aged 35 to 49 years and postmenopausal women aged 50 years or more. The categories of cytologic abnormality referred for colposcopic evaluation included atypical cells of undetermined significance (ASC), low-grade squamous intraepithelial lesion (LSIL), and high-grade squamous intraepithelial lesion (HSIL). A loop electrical excisional procedure (LEEP) was performed in all patients referred with HSIL cytology not explained by colposcopy. Of the 359 patients aged 35 years or older identified, 270 were premenopausal and 89 were postmenopausal. The referral cytology of premenopausal and postmenopausal women was similar with ASC/LSIL in 60% and 65% and HSIL in 35% and 27%, respectively. Postmenopausal women were more likely than premenopausal women to have CIN 3 (41% versus 29%; P < 0.027) and more malignancy (17 versus 0%; P < 0.002). With LEEP, CIN 2 or greater was identified in 71% of the postmenopausal patients and 32% of the premenopausal patients (P < 0.03). These findings show a high prevalence of significant cervical dysplasia among both premenopausal women over the age of 35 years, and postmenopausal women. Compared with younger women, the risk of CIN 2 or greater is at least the same if not higher among these two groups.