Predicting atypical Pap smear progression: a case-control study.

Abstract

Objective: This case-control study proposed to define risk factors for progression of cervical disease beyond an atypical level, and to explore the possibility of a clinical tool that would aid the clinician in deciding on the need for colposcopy.

Methods: Twenty-three hundred (2,300) abnormal Papanicolaou smears were reviewed to identify documented cases of class II Papanicolaou smears that had progressed. Controls were randomly chosen for each case from the remaining pool of available class II Papanicolaou smears that did not progress. Data analyses were conducted to determine the predictive value of information that would be in a patient's chart with respect to progression from class II Papanicolaou smear to a higher level of disease.

Results: A univariate analysis revealed several significant variables, including age, education, attendance at a public clinic, marital status, notification of Papanicolaou results, and a history of sexually transmitted disease. Next, a multivariate analysis demonstrated that a group of significant variables could not be defined, and only notification of an atypical Papanicolaou smear was significant.

Conclusions: The study's findings suggest that the data available in a patient's medical record are not sufficient to develop a risk assessment scale and provide evidence of the need for continued study in this area.