Early Age at First Sexual Intercourse is Associated with Higher Prevalence of High-grade Squamous Intraepithelial Lesions (HSIL)

Caldeira, José Cândido; Dufloth, Rozany Mucha; Vale, Diama Bhadra; Lima, Marcelo Tavares de; Zeferino, Luiz Carlos

doi:10.1055/s-0036-1597973

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Original Article • Rev. Bras. Ginecol. Obstet. 39 (02) • Feb 2017 • https://doi.org/10.1055/s-0036-1597973 copy

Early Age at First Sexual Intercourse is Associated with Higher Prevalence of High-grade Squamous Intraepithelial Lesions (HSIL)

Idade precoce de início da atividade sexual está associada a elevada prevalência de Lesão Intraepitelial Escamosa de Alto Grau

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To evaluate the association of age at first sexual intercourse with the results of the cervicovaginal cytology.

Study Design

Observational analytical study about the prevalence of altered cervicovaginal cytology results in women aged between 18 and 34 years from a densely populated area in Brazil, during 10 years. The patients were stratified into 2 categories according to their age at first sexual intercourse (13-16 years and 17-24 years).

Results

From the total of 2,505,154 exams, 898,921 tests were in accordance with the inclusion criteria. Considering women with 4 years or less from the first sexual intercourse as a reference, those with 5 to 9 years and 10 years or more showed a higher prevalence of high-grade squamous intraepithelial lesions (HSILs). Women with an earlier onset of sexual intercourse (13-16 years) showed higher prevalence ratios for atypical squamous cells (ASC), low-grade squamous intraepithelial lesion (LSIL) and HSIL. The prevalence ratio for HSIL adjusted by age at diagnosis and by age at first sexual intercourse was higher only for women with an earlier onset of sexual intercourse.

Conclusions

The age of first sexual intercourse could be a variable that might qualify the selection among young women who are really at a higher risk for HSIL.

Keywords:
cytology; pap smear; cervical intraepithelial neoplasia; age groups; sexual behavior

	Negative for neoplasm		ASC		LSIL		HSIL
Age group	n	p	n	p	n	p	n	p	Total
18–19 years	87,496	96.62	1,407	1.55	1,357	1.50	296	0.33	90,556
20–24 years	271,989	97.19	3,952	1.41	2,825	1.01	1,082	0.39	279,848
25–29 years	265,488	97.84	3,082	1.14	1,766	0.65	1,017	0.37	271,353
30–34 years	252,823	98.31	2,454	0.95	1,075	0.42	812	0.32	257,164
All age groups	877,796	97.65	10,895	1.21	7,023	0.80	3,207	0.36	898,921
CA statistics¹1 Bano F, Kolhe S, Zamblera D, et al. Cervical screening in under 25s: a high-risk young population. Eur J Obstet Gynecol Reprod Biol 2008;139(1):86-89	34.66		- 18.22		- 35.31		- 2.45
p-value²2 Lowy DR, Schiller JT. Prophylactic human papillomavirus vaccines. J Clin Invest 2006;116(5):1167-1173	< 0.001		< 0.001		< 0.001		< 0.001

Time since first sexual intercourse	Total	ASC			LSIL			HSIL
Time since first sexual intercourse	n	n	p	PR (95%CI)	n	p	PR (95%CI)	n	p	PR (95%CI)
0–4 years	185,896	2,460	1.32	1	2,172	1.17	1	501	0.27	1
5–9 years	306,363	4,018	1.31	0.99 (0.94–1.04)	2,617	0.85	0.73 (0.69–0.77)	1,147	0.37	1.39 (1.25–1.54)
≥ 10 years	406,662	4,417	1.08	0.82 (0.78–0.86)	2,234	0.55	0.44 (0.44–0.50)	1,559	0.38	1.41 (1.28–1.56)
Total	898,921	10,895	1.21		7,023	0.78		3,207	0.36

Age group	Cytology result	Age at first sexual intercourse				PR (95%CI)
		13–16 years		17–24 years
		n	p	n	p
18–24 years	Negative	202,318	96.75	157,167	97.45	−
	ASC	3,303	1.58	2,056	1.27	1.25 (1.18–1.32)
	LSIL	2,569	1.23	1,613	1.00	1.24(1.16–1.32)
	HSIL	929	0.44	449	0.28	1.61 (1.44–1.80)
	Total	209,119	100.00	161,285	100.00
25–29 years	Negative	116,433	97.50	149,055	98.11	−
	ASC	1,517	1.27	1,565	1.03	1.11 (1.07–1.14)
	LSIL	897	0.75	869	0.57	1.14 (1.09–1.20)
	HSIL	572	0.48	445	0.29	1.28 (1.19–1.38)
	Total	119,419	100.00	151,934	100.00
30–34 years	Negative	92,235	97.92	160,588	98.54	−
	ASC	1,078	1.14	1,376	0.84	1.13 (1.09–1.17)
	LSIL	470	0.50	605	0.37	1.13 (1.07–1.19)
	HSIL	407	0.43	405	0.24	1.27 (1.19–1.36)
	Total	94,190	100.00	162,974	100.00

Variable	Category	Adjusted prevalence ratio (95%CI)
Age	18–24 years	Reference
	25–29 years	1.07 (0.99–1.16)
	30–34 years	0.94 (0.86–1.02)
Age at first sexual intercourse	13–16 years	1.65 (1.53–1.77)
Age at first sexual intercourse	17–24 years	Reference

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[1] Address for correspondence Rozany Mucha Dufloth, MD, PhD, Department of Pathology, Hospital do Câncer de Barretos, Rua Antenor Duarte Vilella, 1.331, 14780-000 Barretos, SP, Brazil (e-mail: rozany.dufloth@gmail.com).