Abstract: Abnormal Pap Smear Results at a Free Gynecological Clinic

AUTHORS: Alexa Letizia, BS; Serosh Naeem, MD; Alexandra Kiefer, MD

TITLE: Abnormal Pap Smear Results at a Free Gynecological Clinic

OBJECTIVE: Studies estimate that 3.8% to 10.9% of pap smears are abnormal, and there is no consensus on how this figure is affected by demographic characteristics. Some research demonstrates a higher prevalence of abnormal pap smear results among uninsured and low-income women. The objective of this study was to determine the incidence of abnormal pap smear results in a cohort of uninsured patients at a free clinic.

METHODS: This prospective cohort study was conducted in suburban New York at AccessGYN, a free resident-run clinic in Suffolk County, NY. Data was collected between August 2023 to July 2024 and included demographics and pap smear results.

RESULTS: 44 pap smears were conducted. The average patient age was 40 years, 74% were Spanish-speaking, and their average Area Deprivation Index NY State Decile was 5.5⁶. Seven (15.9%) resulted in abnormal cytology findings. These included ASCUS/HPV negative (n=3), ASCUS/HPV 16+ (n=2), ASCUS/HPV other high risk + (n=1), and HSIL/HPV other high risk + (n=1). Two patients had colposcopy revealing HSIL and eventually had LEEP. One patient with ASC-US had a hysterectomy for abnormal bleeding.

CONCLUSIONS: We found a higher incidence of abnormal pap smear results in our cohort of uninsured patients compared to the rate cited in the literature for the average female patient population. More investigation is needed to determine how insurance status, income, and race can contribute to abnormal pap smear results. We are hoping to share our experience to empower others to make gynecologic care truly accessible to all.