Abnormal Papanicolaou Smear: A Population‐based Study of Risk Factors in Greenlandic and Danish Women

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Abstract
Possible risk factors for abnormal Papanicolaou smear were investigated in a population‐based cross‐sectional study. From Nuuk (Greenland) and Nykebing Falster (Denmark), random samples of 800 women aged 20–39 years were drawn. Totals of 586 and 661 women were included in Greenland and Denmark, respectively. All women went through a personal interview, and had a gynecologic examination including a PAP smear and cervical swab for HPV analysis. A blood sample was taken for analysis of HSV type specific antibodies. Multiple sexual partners was the most important risk factor for abnormal cervical cytology (OR = 4.2). An infectious etiology was also indirectly supported by a relatively protective effect of barrier contraceptive methods (OR = 0.6). The simultaneous finding of HPV 16/18 as a significant risk factor (OR = 2.4) cannot be taken uncritically as support for a causal effect of this HPV type, since such a relationship between cytological changes of the cervix and HPV infection could also emerge if the positive PAP smear was not just a measure of intra‐epithelial neoplasia but also an expression of the infection itself on the cervix.