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Knowledge, Attitude and Practices Regarding Cervical Cancer and Screening Among Women Visiting Primary Health Care Facilities in Kibera Informal Settlement in Nairobi City, Kenya

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• Volume 4, Issue 3
• Enhancing cervical cancer screening: the promise and future of self-sampling HPV testing
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• http://orcid.org/0000-0002-8666-2974 Xiao Li 1 and
• Wenxin Zheng 2
• 1 Department of Gynecologic Oncology , Women’s Hospital, School of Medicine Zhejiang University , Hangzhou , China
• 2 The University of Texas Southwestern Medical Center , Dallas , Texas , USA
• Correspondence to Dr Wenxin Zheng, The University of Texas Southwestern Medical Center, Dallas, Texas, USA; wenxin.zheng{at}utsouthwestern.edu

https://doi.org/10.1136/gocm-2024-000059

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• Public Health

Introduction

Self-sampling human papillomavirus (HPV) testing is a promising approach for cervical cancer screening, particularly in underserved regions. Despite the availability of HPV vaccines, primary cervical cancer screening remains crucial for prevention. The transition from cervical cytology to HPV detection has been one of the significant public health advancements in recent decades. 1 HPV testing is more sensitive and allows for longer screening intervals due to the low risk of cervical cancer with negative HPV results. 2 Importantly, molecular testing provides women with the opportunity to sample themselves. In 2020, the WHO announced a goal to eliminate cervical cancer, with a target to screen 70% of women aged 35–45 years by 2030. 2 However, the burden of cervical cancer remains high, especially in disadvantaged populations, highlighting the need for alternative screening methods such as self-sampling for HPV. 3

Existing limitations

Current insights and methodologies, sampling devices and detection methods.

The first report on self-sampling using cervicovaginal lavage samples for HPV analysis was in 1992. 7 Since then, various collection devices such as brushes, swabs and tampons have been evaluated. In 1999, Hillemanns et al 8 first evaluated self-collected vaginal HPV tests for cervical cancer screening, finding it a reliable method with a sensitivity of 93% for detecting CIN2+. Different detection methods also affect the accuracy of self-sampling, 9 and it is now acknowledged that HPV DNA assays based on clinically validated PCR testing on self-samples are as accurate as those on clinician-obtained samples. 6 However, for HPV mRNA detection, further research is needed as it has not yet been proven for primary screening, although it shows promise in high-risk populations. 2

Acceptability, accuracy and screening efficacy

Evidence from both high-income and low-income areas suggests that self-sampling HPV testing can effectively increase cervical cancer screening uptake and operational feasibility compared with conventional clinician sampling. 10 Self-sampling offers advantages such as privacy, convenience and reduced discomfort. 11 Studies have shown that self-sampling has comparable performance with clinician-collected samples for detecting high-risk HPV infection, with high sensitivity, specificity and negative predictive value. 12 A meta-analysis of test concordance between self-collected and clinician-obtained samples for HPV testing in 26 studies with 10 071 participants showed pooled overall agreement of 88.7% (95% CI: 86.3% to 90.9%). The positive and negative agreements were 84.6% (95% CI: 79.9% to 88.7%) and 91.7% (95% CI: 89.1% to 94.0%), respectively, with a kappa value of 0.72 (95% CI: 0.66 to 0.78). 6 Subgroup analyses indicated that target amplification-based DNA assays (ie, PCR) (90.4%) had the highest overall concordance at 90.4% compared with other assays, which ranged from 82.3% to 86.7%.

In women screened for HPV, self-sampling was non-inferior to clinician sampling for detecting cervical intraepithelial neoplasia grade 2 or worse, with sensitivity ranging from 74% to 92%, specificity from 87% to 94% and negative predictive value greater than 98% across multiple assays. 13 14 Five-year follow-up data from the PaVDaG study showed that the relative sensitivity for CIN3+ and specificity for ≤CIN1 of high-risk HPV testing on self-taken specimens were only slightly lower compared with clinician-collected samples: 0.95 (95% CI: 0.90 to 0.99; PMcN=0.0625) and 0.98 (95% CI: 0.95 to 1.00; PMcN≤0.0000), respectively. 15 Thus, self-sampling showed a similar prevalence of HPV infection and excellent detection rates of CIN2+ and CIN3+ in histology compared with clinical cervical sampling. 14 Accumulated evidence supports the accuracy and effectiveness of self-sampling to increase coverage, especially in developing countries where health resources are limited. 9 This is further supported by the effectiveness of HPV self-sampling to increase coverage among target populations, particularly in developing countries where lack of resources and existing psychological and cultural barriers are significant. 10 16

Future directions

The application of self-sampling HPV testing is expanding globally. As of February 2021, 48 out of 194 WHO member states have adopted primary HPV-based programmes, with 17 incorporating self-sampling in their national programmes, including 2 low-, 5 lower-middle-, 4 upper-middle- and 6 high-income countries. 17 The proportion of self-sampling usage is higher in high-income countries compared with low- and middle-income countries. 17 The WHO recommends self-sampling as part of cervical cancer screening, and the FDA approved self-collected vaginal specimens for cervical cancer screening in May 2024. 18

Looking forward, urine collection as a non-invasive self-sampling method also shows promise for similar sensitivity in detecting CIN2+ compared with cervical samples. 19 This method could provide an even more accessible option for reaching women who are under-screened for cervical cancer. Advances in molecular screening techniques, such as HPV extended genotyping, HPV viral load, E6/E7 mRNA and methylation, may further enhance screening efficacy. These techniques can potentially refine the screening process by identifying specific high-risk populations. Although promising, many of these methods require clinical validation to ensure their accuracy and reliability in primary screening settings. For instance, HPV extended genotyping can differentiate between various high-risk HPV types, which may have different risks of progression to cervical cancer. 20 Assessing HPV viral load in HPV-positive self-collected samples may show increased sensitivity and specificity for detecting CIN2+ lesions, thereby enhancing the effectiveness of the screening process. Similarly, E6/E7 mRNA detection can indicate active viral oncogene expression, which is closely linked to the development of high-grade cervical lesions.

In conclusion, self-sampling is poised to become a primary method for cervical cancer screening. By incorporating advanced molecular techniques, self-sampling can offer a more precise and effective screening strategy as well as controlling costs. This approach has the potential to overcome existing barriers, improve screening acceptability and significantly contribute to the global effort to eliminate cervical cancer.

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

• Wentzensen N ,
• Berkhof J , et al
• de Sanjosé S , et al
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• Medicaid and CHIP Payment and Access Commission
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Contributors XL: conceptualisation; formal analysis; writing—original draft; writing—review and editing; WZ: conceptualisation; writing—original draft; writing—review, editing and finalisation. XL and WZ accept full responsibility for the finished work and/or the conduct of the study, had access to the data and controlled the decision to publish.

Funding This work was supported, in part, by Mark and Jane Gibson Endowment fund, UT Southwestern Medical Center, Texas, USA (grant or award number: not applicable) and Key Research and Development Program of Zhejiang Province, China (2023C03169).

Competing interests None declared.

Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Provenance and peer review Not commissioned; externally peer reviewed.

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New self-swab HPV test is an alternative to Pap smears. Here's how it works.

There's a new way to screen for high-risk HPV, a viral infection that can lead to cervical cancer. This alternative method of collecting samples for cervical cancer screening doesn't require a speculum.

How is HPV related to cervical cancer?

What do cervical cancer screening tests look for, why is cervical cancer screening important.

• How do the self-collection tests work?
• What are the advantages?
• Are there any downsides?

Who should be screened for cervical cancer and how often?

A new option for cervical cancer screening gives patients a less-invasive alternative to conventional tests.

These new "self-collection tests" are scheduled to arrive in doctor's offices nationwide this month. The Food and Drug Administration (FDA) approved self-collection as a method to detect human papillomavirus ( HPV ), the leading cause of cervical cancer, in May. Screening tests are intended to flag people at high risk of cancer or precancer, not to diagnose the disease.

This FDA approval enables patients to collect their own clinical samples for cervical cancer screening. With the rollout of these tests, the U.S. joins Australia, Canada, the Netherlands, Denmark and Sweden, where self-swabbing for HPV is already widely used .

For now, the samples, collected from the vaginal canal, must still be gathered in health care settings, such as doctor's offices. Other countries have allowed at-home self-sampling for HPV, but the method is still pending FDA approval in the U.S.

Here's what you should know about the newly available self-collection tests.

HPV is a common sexually transmitted infection that's primarily transferred through sexual intercourse or skin-to-skin contact. Most sexually active people will contract at least one type of HPV in their lifetime, but the infection normally resolves on its own.

Though more than 30 types of HPV can infect the genitals, only a small number — referred to as "high-risk" HPV — are associated with cancer. Low-risk HPV tends to have no symptoms and clears on its own, although sometimes, genital warts may appear. Nonetheless, this low-risk type of infection rarely leads to cancer.

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Almost all cervical cancer cases are caused by long-term infections with high-risk HPV. A high-risk HPV infection that doesn't go away can lead to abnormal cell growth , which can then turn cancerous down the line.

The HPV vaccine can protect against most cases of cervical cancer. A 2024 study in the Journal of the National Cancer Institute found zero incidence of invasive cervical cancer among young Scottish women who'd received at least one dose of HPV vaccine. Moreover, women who'd received three doses of the vaccine — the number generally recommended — were significantly less likely to develop cervical cancer than unvaccinated women.

In the event someone develops high-risk HPV, there is no cure , but abnormal cervical cells can be removed before they cause cancer.

There are two standard ways to check for cervical cancer: an HPV test and a Pap test.

An HPV test can detect the genetic material of high-risk strains of HPV that, if left untreated, can cause cancer. A Pap test, also called a Pap smear or cervical cytology, checks for changes in cervical cells that could lead to cancer. These changes include the cell's nucleus, which holds its DNA, growing abnormally large, Dr. Nicholas Wentzensen , a senior investigator at the National Cancer Institute's Division of Cancer Epidemiology and Genetics, told Live Science.

An HPV test can also be performed alongside Pap tests in what's called a co-test. The combined test can detect high-risk HPV and cervical cell changes using the same sample. The recommendations for who should get which test and how frequently varies with age and other health factors (see later section for details).

It is important to note that these are not diagnostic tests. Instead, their intent is to flag individuals at high risk of developing cancer or precancer. A positive result on any of these tests would require further testing — often a colposcopy-directed biopsy — to receive a diagnosis. .

Both conventional HPV tests and Pap tests have traditionally required a sample of cells collected from the cervix , the narrow canal that connects the uterus and vagina. during a pelvic exam performed by a doctor. The sample, taken during a pelvic exam*, is taken by a doctor who inserts a speculum into the vagina to widen it and then scrapes the cervix with a brush or spatula.

But now, the FDA has approved a far less invasive option: patients can now self-sample in a health care setting and use cells from the vagina, rather than the cervix. Studies have shown that samples from the vagina are just as effective for detecting HPV as those taken from the cervix and that no significant difference exists between self-collected and doctor-collected samples for HPV detection.

*Note that cervical cancer screenings and pelvic exams are not the same thing, although they're often performed at the same time. Pelvic exams are used to check on the health of female reproductive organs.

Cervical cancer screening has been found to greatly reduce death rates from cervical cancer. For example, in England, regular screening is estimated to reduce cancer mortality by 70%, according to a 2016 study published in Nature . The idea is that, with routine screening and follow-up tests, cancer can be detected and treated early before it progresses to a more advanced, treatment-resistant stage of the disease.

The National Cancer Institute estimates that about 11,500 new cases of cervical cancer are diagnosed in the U.S. every year. About half of these cases end up being diagnosed in patients who were not adequately screened, per current guidelines , or who had not undergone any screening at all.

Ideally, the tests prevent cancer deaths by detecting precancerous changes in cells early, when treatment is most beneficial. However, they can also pick up full-blown cancer in the event it's already developed. In either case, a positive screening test would then lead to formal diagnostic testing.

How do the new self-collection tests work?

If opting to use the new self-collection tests, a patient should receive instructions on how to do so from their medical provider. The patient will complete the test in the clinic, but no medical supervision is required during the self-collection itself. In other words, a doctor doesn't need to be in the room when the sample is collected.

Generally, the patient is instructed to insert a long cotton swab into the vagina and then gently swirl it for 20 to 30 seconds to collect an adequate sample. The sample is then left at the health care provider's office, and from there, it is sent to a lab for analysis.

What are the advantages of self-collection compared with a Pap smear?

The new self-collection option has the potential to increase the number of people who get cervical cancer screenings across the U.S. The hope is that these tests, which are more convenient and less invasive than the traditional screening approaches, will help reach patients who may forgo Pap tests for various reasons.

For many patients, screenings that involve a speculum can mean physical and emotional discomfort, said Dr. Ilana Cass , a gynecologic oncologist at Dartmouth Hitchcock Medical Center and a professor of Obstetrics and Gynecology at Dartmouth College in New Hampshire. A Pap smear can be triggering particularly for patients with a history of sexual violence, older patients with more sensitive vaginal tissues, and people with gender dysphoria .

"If we are able to invite more people in for testing through these expanded technologies, who would have previously been uncomfortable or would have been uninterested, this is really great. This is progress," Cass told Live Science.

Are there any downsides to the self-collection tests?

A meta-analysis of studies, published in Nature , found that self-collected vaginal samples are comparable to cervical samples collected by a doctor, in terms of their ability to reveal HPV. One study included in the analysis found that tests that used self-collected samples were about 89% accurate at detecting HPV. By comparison, doctor-collected samples garnered nearly 88% accuracy.

Nonetheless, patients may have concerns about self-collection, Cass noted. These are often legitimate worries about performing the test correctly and getting a good enough specimen. Although self-collection will always be somewhat susceptible to user error, the method is highly sensitive — even if a patient collects only a small number of cells, the tests can adequately detect HPV.

The American Cancer Society (ACS) recommends that regular cervical cancer screenings begin at age 25. These guidelines are the most up-to-date, as the recommendations from the U.S. Preventive Services Task Force — another expert group — are currently being revised, Wentzensen told Live Science.

According to the ACS guidelines:

• Adults with a cervix who are between the ages of 25 and 65 should have a primary HPV test every five years. A primary HPV test is one that tests for HPV alone and is not combined with a Pap test.
• Alternatively, a co-test, which combines an HPV test and a Pap test, can be done every five years.
• Or, a Pap test alone can be done every three years.

It is important to note, however, that primary HPV tests are the gold-standard screening method to prevent cervical cancer. They are better than Pap smears at finding precancerous changes in cervical cells.

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More frequent screening schedules than the one described above may be recommended for patients with a personal or family history of cervical cancer, or for those who have HIV or a compromised immune system. The important takeaway is to get screened regularly and follow through with recommended follow-up tests, to catch abnormalities early when treatment has the greatest chance of success.

This article is for informational purposes only and is not meant to offer medical advice.

Ever wonder why some people build muscle more easily than others or why freckles come out in the sun ? Send us your questions about how the human body works to [email protected] with the subject line "Health Desk Q," and you may see your question answered on the website!

Julie Goldenberg is a journalist based in New York City. She was a former associate editor at AARP where she reported on aging in America. Her work has appeared in AARP the Magazine, AARP.org, and Forbes. She holds a Master of Science degree in Journalism from Columbia University's Graduate School of Journalism and a Bachelor's degree in psychology from McGill University.

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Obstetrics & gynaecology

The importance of early cervical cancer screening: what women should know.

Cervical cancer is a major health concern for women worldwide. However, with advancements in screening and prevention, the chances of early detection and successful treatment have improved dramatically.

This article provides an expert insight into cervical cancer screening , highlighting when to start, what the screening process involves, and what to do if abnormal cells are detected.

At what age should women start getting screened for cervical cancer?

In the UK, health guidelines recommend that women begin cervical cancer screening at the age of 25 .

Women aged 25 to 49 should be screened every three years, whilst those aged 50 to 64 should have screening every five years. Women over 65 may not need to continue screening if they have had regular screenings in the past and haven't had serious pre-cancerous conditions.

It's essential for women to be aware of these recommendations, as starting screening at the right age can significantly reduce the risk of cervical cancer.

Why is early cervical cancer screening important?

Early screening is important because it can identify abnormal cells in the cervix before they develop into cancer . These abnormal changes are often referred to as cervical intraepithelial neoplasia. If detected early, these changes can be monitored or treated, significantly lowering the risk of developing invasive cervical cancer.

In addition, cervical cancer often shows no symptoms in its early stages , which is why regular screening is so essential. As the disease progresses, women may experience abnormal vaginal bleeding - such as bleeding between periods, after intercourse, or post-menopausal bleeding - along with pelvic pain and unusual discharge.

What does cervical cancer screening consist of?

Cervical cancer screening typically involves a Pap test (or Pap smear) . You will be advised to avoid sexual intercourse, douching, or using vaginal medications for 48 hours before the test to ensure accurate results.

During your screening appointment, a speculum will be gently inserted into the vagina to allow your gynaecologist to view the cervix. A small brush or spatula will then be used to collect cells from the surface of the cervix. This process may cause mild discomfort but it’s generally quick, lasting only a few minutes.

In some cases, a test for HPV (human papillomavirus) may be performed simultaneously. HPV is a virus frequently linked to cervical cancer.

What happens if abnormal cells are found?

If your screening results reveal abnormal cells, your gynaecologist will explain the next steps to follow. This may involve:

Follow-up tests

• Colposcopy : A colposcopy is a more in-depth examination of the cervix conducted with a specialised magnifying instrument. If any areas appear abnormal, a biopsy may be performed to collect tissue samples for further analysis.
• Biopsy : A biopsy involves removing a small amount of tissue from the cervix to be examined under a microscope. This helps to determine whether cancer is present.

Treatment options

Depending on the findings, treatment may include:

• Monitoring : In cases where only mild abnormalities are detected, your gynaecologist may recommend a watch-and-wait approach with regular follow-ups.
• Procedures : For more significant abnormalities, treatments may include cryotherapy (freezing abnormal cells), LEEP (loop electrosurgical excision procedure), or other surgical options to remove affected tissue.

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• Asia Pac J Oncol Nurs
• v.5(3); Jul-Sep 2018

A Study on Cervical Cancer Screening Using Pap Smear Test and Clinical Correlation

Pushp lata sachan.

1 Department of Physiology, Career Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Meenakshi Singh

2 Department of Obstetrics and Gynaecology, King George Medical University, Lucknow, Uttar Pradesh, India

Munna Lal Patel

3 Department of Medicine, King George Medical University, Lucknow, Uttar Pradesh, India

Rekha Sachan

The objective of the study is to evaluate the use of the Pap smear screening method for detection of precancerous lesions.

All women who visited the outpatient gynecology clinic of the Department of Obstetrics and Gynaecology at King Georges Medical University, Lucknow, UP, India, over 1 year for different clinical problems were recruited for the study. A total of 1650 women who were sexually active and over 21 years of age were enrolled in the study. A clinical examination, an examination per speculum, and a vaginal examination were performed and a history taken for all women. A Pap smear was used for all women to screen for cervical cancer. The smear was obtained using an Ayre spatula and spread over a marked glass slide, which was placed in 95% ethyl alcohol and sent to the Department of Pathology for cytopathological examination. All data were recorded using a predetermined pro forma. Women who had visible malignant cervical lesions were excluded from the study.

Most women were in the age range of 30–50 years and multiparous. Vaginal discharge was the most common complaint, occurring in 36.96% of the women. An irregular menstrual cycle was the complaint of 12.78% and abdominal pain of 25.63% of women, while 15.15% were asymptomatic. The Pap smear test of 93.57% of the women was adequately taken, while 6.42% of the individuals had an inadequate sample. The test was negative for malignancy in 48.84%, and 42.66% had infection or inflammation. Atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), and high-grade squamous intraepithelial lesion (HSIL) were detected in 2.90%, 5.09%, and 0.48%, respectively. Women with Pap tests positive for ASCUS, LSIL, and HSIL underwent a colposcopy and guided biopsy.

Conclusions:

Women with an abnormal Pap test should undergo a colposcopy, and those with abnormal colposcopy findings should be advised to undergo a biopsy. A Pap smear is simple, noninvasive, cost-effective, and easy to perform for detection of precancerous lesions in a gynecological patient.

Introduction

Cancer of the cervix is an increasing health problem and an important cause of mortality in women worldwide. The incidence of cervical cancer arises worldwide. The difference in incidence between developing and developed countries, where cervical cancer cases have been significantly reduced, is large. In developing countries like India, the burden of cervical cancer is still high. According to the World Cancer statistics, >80% of all the cervical cancer cases are found in developing and low-resource countries, because of a lack of awareness and difficulty in running cytology-based screening programs.[ 1 ] More than one-fifth of all cervical cancer deaths occur in India.[ 2 ] Every year, 122,844 women in India are diagnosed with cervical cancer, and 67,477 women die from the disease.[ 3 ]

Cervical cancer is a preventable disease due to the long preinvasive stage. Early detection and appropriate treatment are possible if robust screening is implemented.[ 4 ] Early cervical epithelial changes can be identified by a Pap smear test, which is the primary screening test for detection of precancerous cervical intraepithelial neoplasia and the early stage of invasive cervical cancer.

Due to widespread screening programs, there has been a significant reduction in mortality from cervical cancer in developed countries.

The overall sensitivity of the Pap test in detecting a high-grade squamous intraepithelial lesion (HSIL) is 70.80%.[ 5 ] A Pap screening done in association with an HPV DNA test increases the sensitivity for early detection of precancerous lesions.[ 6 ]

There is a need to spread cervical cancer screening awareness programs, educate women regarding the symptoms of cancer, and motivate them to visit the hospital for a cancer screening. Women and all family members should be counseled about the need for cancer screening. Pap smear-positive women need adequate treatment and regular follow-up. Thus, we have to strengthen our health services and health-care system to include screening at primary health centers.

The aim of the present study was to evaluate women for precancerous lesions using the Pap smear test and investigate clinical correlation.

This prospective study was carried out over 1 year at the Department of Obstetrics and Gynaecology in Queen Mary's Hospital, part of King George Medical University, Lucknow, India. We screened 1650 sexually active women who were more than 21 years of age. Women with different complaints, including vaginal discharge, blood-mixed discharge, foul-smelling discharge, postcoital bleeding, intermenstrual bleeding, postmenopausal bleeding, abdominal pain, infertility, and secondary amenorrhea, were included in this study. Those not willing to participate in the study had a frank growth, had been treated for cervical cancer, or were pregnant were excluded from the study. A detailed history was taken using a predetermined pro forma that included the chief complaint and the findings of per speculum and vaginal examinations.

Written informed consent was obtained from all women. Patients were placed in the lithotomy position, and a sterile bivalve speculum was inserted into the vagina. The posterior vaginal wall was retracted posteriorly and the anterior vaginal wall anteriorly to allow proper visualization of the cervix and vaginal wall.

A sample was taken from the ectocervix by rotating a wooden Ayre spatula 360°. The sample was quickly smeared onto a labeled glass slide and fixed with 95% ethyl alcohol in a jar. The glass slides were sent to the Department of Pathology for cytopathological examination. Laboratory results were reported according to the new Bethesda System for Reporting Cervical Cytology 2014. The system broadly divides lesions into those negative for intraepithelial neoplasia and epithelial cell abnormalities (ECA) that include squamous and glandular cells.

Women who had abnormal Pap test results, including atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), and HSIL were sent for a colposcopic examination. Women who had an abnormal colposcopic finding, i.e., a Reid score 6 or above, underwent a colposcopy-guided biopsy. Treatment was provided according to the stage of the disease.

In this study, most women (54) with LSIL belonged to the 41–50-year-old age group, followed by 17 women who belonged to the 51–60-year-old age group. HSIL was found mostly in women 41–50 years of age [ Table 1 ]. Most women with LSIL had four or more children. This indicates that multiparity (>3) is a significant risk factor for cervical carcinoma.

Demographic Profile of patients

Most women in the study were Hindu, not Muslim. May be fewer Muslim women came to the hospital because of their religion, shyness, or they were unaware of the cervical cancer screening program. Most women belonged to rural communities versus urban areas because the government runs the cervical cancer screening awareness program in rural areas [ Table 1 ].

White vaginal discharge was the most common symptom found in 36.96%, abdominal pain in 25.63%, an irregular menstrual cycle in 12.78%, postcoital bleeding in 3.09%, and postmenopausal bleeding in 1.45% of the women [ Table 2 ].

Symptoms of women attending gynaecological outdoor

Table 3 shows that on perspeculum examination white discharge was commonly found in 29.69% of the participants, cervical erosion was present in 19.21%, hypertrophy of the cervix was found in 10.84%, and cervical bleeding on touch was found in 4.84%. Cases with chronic cervicitis and cervical bleeding on touch had epithelial abnormalities.

Per speculum examination findings of gynaecological cases

Table 4 shows that 48.84% of the participants were negative for malignancy and 42.66% had inflammation. The epithelial abnormalities ASCUS, LSIL, and HSIL were found in 2.90%, 5.09%, and 0.48% of the women, respectively. Unsatisfactory reporting occurred for 6.42%, while the remainder had adequate sample reporting.

According to epithelial cell abnormality

The results in Table 5 show that the most abnormal Pap smear findings were found in patients with symptoms of white vaginal discharge, followed by patients with abdominal pain. No LSIL and HSIL was found for patients with postcoital bleeding, and HSIL was found in only two patients with postmenopausal bleeding.

Correlation of pap smear finding with symptoms

The incidence of cervical cancer is quite high because prevention programs are either nonexistent or poorly implemented. The Pap smear test used as a screening method to detect cervical cancer is an effective way to prevent the development of cervical cancer, but awareness within the community about the Pap smear test is very low. According to the American Cancer Society (2012), the Pap smear test is a routine cancer screening method that should be done every 3 years, and a Pap smear with an HPV DNA test is recommended as a screening method every 5 years.[ 7 ]

In the present study, most of the abnormal cytology was detected in patients in the age group between 40 and 60 years. LSIL and HSIL were found in 5.09% and 0.48% of the women in this age group, respectively. Gupta et al .[ 8 ] reported that most of the abnormal cytology cases, i.e., 40.37%, in their study were in the age group of 30–39 years, followed by 35.96% in the age group of 20–29 years. LSIL was found in 1.36% (age group of 30–39 years) and HSIL in 0.91% (age group of 40–49 years). Vaghela et al .[ 9 ] reported that LSIL was the most common epithelial abnormality, found in 12.4% of their individuals, followed by HSIL in 5% of the cases. For all epithelial abnormalities, the average age of the women was 49 years.

White vaginal discharge was the most common complaint of the women in our study at 36.96%, similar to the rate in other studies.[ 10 , 11 ]

The Pap smear was negative for malignancy in 48.84%, but 42.66% had inflammation. Other studies[ 12 , 13 ] reported 95% and 74.5% had inflammation indicated by the Pap smear test, respectively. A few studies[ 14 , 15 ] reported that women with persistent inflammation should be appropriately treated; otherwise, the chance of development of cervical intraepithelial lesions increases. A repeat Pap smear should be taken after proper antibiotic treatment.

Our study had an unsatisfactory report rate of 6.42%, which might have been due to dryness of the smear or a technical error. The 4.8% unsatisfactory report rate reported by Vaghela et al .[ 9 ] might have been due to proper training of personnel and the use of the proper technique.

ECA was detected in 8.48% of our screened women, a result comparable to the ECA detection rates of 9.05%, 12.60%, and 11.95% in the studies performed by Al Eyd et al .,[ 16 ] Patel et al .,[ 6 ] and Sarma et al .,[ 17 ] respectively.

In our study, the ECA ASCUS was found in 2.9% of screened women, LSIL in 5.09%, and HSIL in 0.48%, results comparable to those in a study done by Verma et al .,[ 18 ] who found ASCUS in 1%, LSIL in 5.5%, and HSIL in 2.5% of their screened women. Padmini et al .[ 19 ] also reported ASCUS (8%), LSIL (5%), and HSIL (3%) in women screened with the Pap smear test. Higher numbers of LSIL (8.6%) and HSIL (3.8%) lesions were found in a study by Nayani and Hendre.[ 20 ] The high prevalence of cytological abnormality observed in Indian studies might be due to cultural differences, age of the individuals, incidence of related infections, awareness about screening, and the presence or absence of cervical screening programs in different parts of the country. A Saudi Arabian study[ 21 ] had a 4.9% detection rate for the epithelial pathological diagnosis of SIL. The higher SIL rate was a result of a lack of awareness about screening and a lack of screening programs. In contrast to our study, Saha et al .[ 22 ] reported ASCUS (5.92%) to be the most common cytological abnormality.

Cervical cancer commonly develops in women between the ages of 40 and 50 years and its precursor lesion usually occurs 5–10 years earlier. Therefore, it is recommended that women should have at least one Pap smear test before the age of 45 years.[ 23 , 24 ]

Pap smear testing is a very useful, simple, economical, and safe tool for detecting precancerous cervical epithelial lesions. It should be established as a routine screening procedure to reduce the treatment burden, morbidity, and mortality. Every woman above the age of 30 years should undergo routine cervical cancer screening, even into the postmenopausal period. The Pap test has been regarded as the gold standard of cervical screening programs. When the Pap test is combined with an HPV DNA test, the sensitivity for detection of cervical pathology is increased. The community should be educated about the Pap smear test, including its goal and the required frequency of application, by widespread educational and media programs. Most women who visited an outpatient clinic are not aware of cervical cancer screening. Thus, there is a need to spread cancer screening programs to help prevent mortality and morbidity due to cervical cancer.

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There are no conflicts of interest.