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Introduction

Cervical dysplasia or cervical intraepithelial neoplasia (CIN) is the precursor to cancer of the cervix, a cancer of adult females of which there are nearly 10,000 new cases each year in the United States and nearly 4,000 annual deaths. Infection of the cervix with the human papillomavirus (HPV) is the cause of cervical cancer. Risk factors for HPV infection in the adolescent years include early sexarche (onset of coitus), multiple sexual partners, smoking, chronic steroid use, and conditions of immunosuppression (ie, transplants, human immunodeficiency virus infection). (1) Cervical cancer screening in adolescent females is an important weapon in the fight against cervical cancer, and this article considers current concepts on this topic.

Pathology

Pediatricians should be knowledgeable about gynecologic care of the sexually active adolescent. (2) Many may perform Papanicolaou (Pap) test screening; others may prefer to work closely with a gynecologist or other health-care professional who sees adolescents. The basis of cervical cancer screening is the evaluation of the epithelial surface of the cervix (ectocervix), which changes from squamous to columnar epithelium. (2) The border that joins the two types of epithelia is called the squamous columnar junction or transition zone. More than 95% of CIN develops within this transition zone of the cervix in adult females.

Under the influence of maternal hormones, cervical columnar cells increase in the neonatal period, but the cells recede during childhood. During puberty and pregnancy, the squamous epithelium is replaced by columnar epithelium, sometimes leading to a red, granular appearance to the endocervix, which …