Factors Associated with Development of High-Grade Squamous Intraepithelial Lesions of the Uterine Cervix in Women Younger than 30 Years

Abstract

Objective: To determine the factors associated with the increased risk of developing high-grade squamous<br />intraepithelial lesions (HSIL) of the uterine cervix in women younger than 30 years compared with those aged ≥ 30<br />years who also had HSIL. Methods: Patients with HSIL who underwent loop electrosurgical excision procedure (LEEP)<br />between January 2006 and July 2017 at Chiang Mai University Hospital were retrospectively reviewed. We analyzed<br />the factors associated with the development of HSIL by comparing two age groups between women aged < 30 years<br />and those aged ≥ 30 years. The factors analyzed included the well-recognized risk factors for cervical cancer, i.e. age<br />at sexual debut, number of sexual partners, use of oral contraceptive (OC) pills, smoking history, sexually transmitted<br />diseases and HIV status. Univariate and multivariate logistic regressions were used to assess factors associated with<br />the increased risk of developing HSIL in women younger than 30 years compared with those aged ≥ 30 years. Results:<br />During the study period, there were 345 patients with HSIL, 30 were < 30 years (case group) and 315 aged ≥ 30 years<br />(control group). By multivariate analyses , early sexual debut(OR, 2.86; 95% CI, 1.01-8.13; P=0.047), multiple sexual<br />partners (OR, 2.94; 95% CI, 1.23-7.02; P=0.015), history of genital warts (OR, 20.46; 95% CI, 2.27-183.72; P=0.007)<br />and history of smoking (OR, 2.95; 95% CI, 1.10-7.93; P=0.032) were significantly associated with the development<br />of HSIL in women younger than 30 years when compared with those aged ≥ 30 years. The OC use, HIV status and<br />underlying diseases were not significantly different in both groups. Conclusion: Early age at sexual debut, multiple<br />sexual partners, history of genital warts and smoking are significant risk factors for developing HSIL in women younger<br />than 30 years. Cervical cancer screening should be considered in young women with such factors.