Transcript Pap smear findings among Women screened for cervical cancer at

PAP SMEAR FINDINGS AMONG
WOMEN SCREENED FOR
CERVICAL CANCER AT THE
NATIONAL OBSTETRIC FISTULA
CENTRE, ABAKALIKI,
SOUTH-EAST, NIGERIA
BY
Dr OKENWA SAMUEL CHIMA
AUTHORS
 Ekwedigwe K.C, Daniyan ABC, Sunday-Adeoye I,
Mbamalu S.O, Okenwa S.C, Iyare F
OUTLINE
 Introduction
 Methodology
 Result
 Discussion
 Conclusion
 Recommendation
ABSTRACT
 BACKGROUNG: Pap smear also known as Pap test is a procedure used to
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screen for cervical cancer which is the most common gynaecological cancer
in women.
OBJECTIVE: The study reviews findings among women screened for
cervical cancer at the National Obstetric Fistula Centre with the aim of
determining those with the premalignant phase.
METHOD: This is a cross sectional retrospective study. The case records of
316 patients who had undergone cervical screening between August 2012
and March 2013 were reviewed for biological, social and cytology findings.
Analysis of data was done using SPSS statistics version 21.
RESULTS: Majority (33.5%) of patients screened were within ages
30 – 39years, significantly (75.3%) married women presented for
screening, most (57.6%) of the patients were civil servants.
Vaginal examination did show 87.7%had normal findings and 2.5% had
abnormal bleeding. 66.5% were negative on visual inspection by acetic acid
and the Pap smear results showed 50% of patients had normal findings
and 26.6% had inflammatory cells on cytology. Only 0.6% showed
dysplasia on pap smear.
CONCLUSION: The study showed a high awareness among married
women and majority of women had normal Pap smear findings.
KEYWORD: PAP SMEAR, CERVICAL CANCER.
INTRODUCTION
 Cervical cancer is the most common
gynaecological cancer only second to breast
cancer in women1
 The incidence of cervical cancer in Nigeria
is 250/100000 per year2
 This condition is largely preventable by
effective screening programmes3
 Pap smear is a screening test for cervical
cancer
 The test was invented by and named after a
Greek doctor George Papanicolaou in 19284
 Pap smear is regarded to be very specific
but only moderately sensitive5
METHODOLOGY
 This study was done at the National Obstetric Fistula
Centre, Abakaliki, South-East, Nigeria from August
2012 to March 2013
Study Population:
 Women who have attained reproductive age status
Study Design:
 A retrospective study
Sample size
 A total of 316 women entered for this study, women
who had presented for cervical cancer screening
 The biological, social and cytological findings of these
women screened were documented for the basis of this
study
Sampling Technique: Convenient sampling method was
used and analysis was done using SPSS vs. 21
Inclusion Criteria: Women who have attained
reproductive age and have commenced sexual activities
Exclusion Criteria:
* Women who are menstruating
* Women with obvious cervical lesions
Limitation of Study: Visual inspection by Lugol’s
iodine was not done
SOCIODEMOGRAPHIC VARIABLES
n=316
Age
<20
20-29
30-39
40-49
50-59
>59
0
1
2-4
>4
Parity
SINGLE
MARRIED
Marital status
DIVORCED/SEPARATED
WIDOW
FARMING
TRADER
STUDENT
Occupation
CIVIL SERVANT
NONE
ARTISAN
%
3
37
106
96
57
17
0.9
11.7
33.5
30.4
18
5.4
34
19
64
199
10.8
6
20.3
63
17
238
5.4
75.3
2
58
0.6
18.4
182
47
12
57.6
14.9
3.8
47
11
17
14.9
3.5
5.4
VAGINAL EXAMINATION
Frequency
Percent
NORMAL
277
87.7
8
2.5
20
6.3
IUCD THREAD
2
.6
DISCHARGE
9
2.8
316
100.0
BLEEDING
LESION
Total
VIA
Frequency
Percent
POSITIVE
106
33.5
NEGATIVE
210
66.5
Total
316
100.0
PAP SMEAR RESULT
Frequency
NORMAL FINDINGS
Percent
158
50.0
INFLAMMATORY
84
26.6
UNSACTISFACTORY
72
22.8
2
.6
316
100.0
DYSPLASIA
Total
Relationship Between Pap Smear findings and
VIA
PAP SMEAR RESULT
NORMAL FINDINGS
INFLAMMATORY
Total
UNSACTISFACTORY
DYSPLASIA
POSITIVE
53
31
22
0
106
NEGATIVE
105
53
50
2
210
158
84
72
2
316
VIA
Total
P>0.05
RESULT
 Majority (33.5%) of patients screened were within ages
30 – 39 years, with a mean age of 40.7 + 10.7years. Most
patients were Para 4 and above
 Significantly (75.3%) married women presented for
screening, of which most (57.6%) were civil servants
 Vaginal examination did show 87.7% had normal
findings and 2.5% had abnormal bleeding
 On visual inspection by acetic (VIA) acid 66.5% were
negative
RESULTS contd
 Pap smear results showed 50% of patients had normal
findings and 26.6% had inflammatory cells
 Only 0.6% showed dysplasia on pap smear
 There is no statistical significant difference between Pap
smear findings and VIA findings
DISCUSSION
 From the result, majority were above the age of 30 years,
this result is similar to studies FETHA Abakaliki6 but
varies with a study done in Nnewi where majority of the
respondents where between ages 25 – 29years7
 Most of the women were married, this is in keeping with
similar studies done in South-East Nigeria7 and North
Central Nigeria8
 A significant number of patients screened 87.7% had
normal findings on vaginal examination
DISCUSSION contd
 On visual inspection by acetic acid, majority of the
patients screened tested negative, this result is similar to
a study done in India9 but varies with a study done in
Khartoum, Sudan10
 Results from pap smear taken from screened patients
showed 50% of patients had normal findings and only
0.6% showed dysplasia; this is similar to previous study
done in Turkey10 and India12
 Only 2 (0.6%) of the patients screened showed dysplasia
on pap smear and these 2 were VIA negative. However,
there is no statistical significance difference between Pap
smear finding and VIA findings on cervical screening.
CONCLUSION
 This study showed a high awareness cervical cancer
screening among married women and majority of the
women had normal Pap smear finding
 This study also showed that VIA had sensitivity
comparable to Pap Smear
RECOMMENDATION
 For complete cervical cancer screening; VIA, Visual
inspection with Lugol’s iodine(VILI) and Pap Smear
Should be employed
 However, in low resource settings VIA alone can be
used as a screening tool
References
1.
Mahmood IS. Premalignant and malignant disease of the cervix. Dewhurts
Gynaecological Obstetrics. 7th Ed; 2007;614
2. Pisani P, Parkin DM, Bray F, Ferley J. Estimates of the worldwide mortality from 25
cancers in 1990. Int J Cancer 1999;83:870-3
3.
Maheck et al., 1994; Yaren et al., 2008
4. Palatianos GM, Cintron JR, Narula T. George N. Papanicolaou, MD. Father
of modern cytology. A 30-year commemorative. J Fla Med Assoc. 1992;79:837-838.
5.
Cervical Screening Presentations; For Providers of Medical Practioner Education
in Queensland; 20:10:2014
6. Chinaka CC, Udeajah VN. Awareness of cervical cancer screening among women
visisting Federal Teaching Hospital Abakalik, Nigeria. Journal of App Med Sci. 4;
2012: 47 - 66
7.
Obafunwa et al., 1999; Apgar et al., 2001; Sharp et al., 1987
8.
Oche MO, Kaoje AU, Gana G, Ango JT. Int J of Med and Med Sci; 5(4); 2013;184-190
9. Bhavana S, Anita D, Geeta D, Yeshita P, Hema D. Cervical Cancer Screening by
Visual Inspection with Acetic Acid – Interobserver Variability between Nurses and
Physicians, Asian Pacific JCancer Prevention. 11;2010;619-622
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visual inspection with acetic acid screening in sudan
11. Ayten D. Pap screening result for Turkish pregnant women. Asian Pacific J Cancer
Prevention. 13(11) 2012;5835-5838
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