Screening patterns are changing constantly and most of them do not take into consideration younger patients. Most of the High-grade Squamous Intraepithelial Lesions (HSIL) carries a higher risk of progression to cervical cancer given that 40% to 50% of HSIL progress. The aim of this study was to demonstrate the importance of giving relevance to these patients and that age is also a factor for the risk of disease progression, since LSIL patients are not aggressively treated in these younger patients.
A total 1,072 samples with HSIL or higher lesions were obtained from a pool of 32,620 samples with a dysplasia diagnosis out of a total of 227,946 patients from OB/GYN clinics around Puerto Rico in 2015. The samples were rescreened and classified following TBS criteria for HSIL or higher and then divided by age. Out of the 1,072 samples, 186 of them were tested to determine the risk of progression for overexpression of HPV E6/E7 mRNA, using the OncoTect assay test (IncellDxTM), and was classified as positive in cases where >2% of cells showed overexpression of E6/E7 mRNA.
From these samples, 17.3% of the cases were positive using the OncoTect assay test (IncellDxTM). From 1,072 HSIL or higher cytology samples, the age distribution were: ≤25 (16%), 26-35 (34%), 36-45 (22%), 46-55 (12%), and ≥56 (17%), were 50% of the cases fell under 35 years of age, while the progression risk was: ≤25 (17%), 26-35 (38%), 36-45 (23%), 46-55 (8%), and ≥56 (15%).
This study demonstrated that a relevant percentage (50%) of the patients with HSIL or higher lesions was in the range of 35 years or less, showing that this group had the same percentage of progression to that of older patients. Knowledge that a HSIL or higher lesions prevalence in younger women is by no means negligible, transient or productive HPV infection in this group age is prevalent. Although cytology interpretation has its limitations, it is always best to add more knowledge towards qualifying reports. It is necessary to take early care of these younger patients with HSIL or higher lesions and positive for overexpression of HPV E6/E7 mRNA in the long run, so as to reduce the risk of progression of disease in the Puerto Rican population.