Date of Award

January 2012

Document Type

Open Access Thesis

Degree Name

Master of Science in Nursing (MSN)

Department

Yale University School of Nursing

First Advisor

Alison Moriarty-Daley

Second Advisor

Linda Niccolai

Abstract

Objective: To quantify the number of adolescent females <21 with pre-cancerous cervical lesions or cervical intraepithelial neoplasia (CIN) 2+/AIS in the state of Connecticut and identify any correlates which may be associated with CIN 3.

Methods: CIN 2+/AIS precancerous cervical lesions are a reportable condition in the State of Connecticut for the purpose of public health surveillance. A subset of this data (681 women) under 21 years of age was analyzed for the years 2008-2010.

Results: Of the 681 records, 478 (70.2%) women had CIN 2, 92 had CIN 2/3 (13.5%), and 110 (16.2%) had CIN 3. The highest annual rates for CIN 2+/AIS were found in Litchfield (342.98/100,000) and New London (287.85/100,000) counties. CIN 3 occurred at an average rate statewide of 38.6/100,000 per year for women ages 13-20. The majority of adolescents with pre-cancerous cervical lesions CIN 2+/AIS (70%) were 19 and 20 years of age. CIN 3 vs. CIN 2 was not found to be associated with age, insurance status, specimen collection year, or living in a rural vs. urban county. However, the association between diagnosis and county level income was highly significant; adolescents with pre-cancerous lesions living in counties with lower median incomes were 2.3 times more likely to have CIN 3 vs. CIN 2.

Conclusion: Rates of CIN 2+/AIS and CIN 3 vary widely by geographic area. Practitioners should be reassured that the majority of cases of pre-cancerous cervical lesions are CIN 2 and therefore, likely to regress. CIN 3 rarely occurs in adolescent females under age 19; however, if young women do not initiate screening at age 21 or shortly thereafter, we may seen an increase in cervical cancer among young women in their twenties and thirties, especially among unvaccinated women and women living in low income areas.

Comments

This is an Open Access Thesis.

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