ASSESSMENT OF PAP SMEAR FINDINGS AMONG WOMEN ATTENDING GYNAECOLOGY OUTPATIENT DEPARTMENT AT A TERTIARY CARE CENTER
Main Article Content
Keywords
Pap smear, cervical cancer screening, cytological abnormalities, Bethesda System, women's health
Abstract
Introduction: Cervical cancer remains a significant public health concern in India, ranking as the second most common cancer among women. Papanicolaou smear screening provides an effective method for early detection of cervical abnormalities. This study aimed to assess the pattern and prevalence of Pap smear findings among women attending gynaecology outpatient services.
Methods: A cross-sectional descriptive study was conducted at JIET Medical College & Hospital from December 2023 to May 2024. Five hundred women aged 21-65 years were systematically sampled from the Gynaecology OPD. Conventional Pap smears were collected and analyzed according to Bethesda System 2014 guidelines. Data on demographic characteristics, risk factors, and clinical presentations were collected using structured questionnaires.
Results: Among 500 participants, 476 (95.2%) specimens were adequate for evaluation. Normal cytology was observed in 398 (83.6%) cases, while epithelial cell abnormalities were found in 33 (6.9%) cases. ASC-US was the most common abnormality (3.8%), followed by LSIL (1.5%) and HSIL (0.6%). Significant risk factors included early age at marriage (p=0.032), higher parity (p=0.045), and tobacco use (p=0.019). Women aged 51-65 years showed the highest proportion of high-grade abnormalities (7.9%). Educational status significantly correlated with screening awareness, with only 23.7% having previous Pap smear history. Conclusion: The study revealed a substantial burden of cervical abnormalities with concerning patterns in older women. The findings emphasize the need for organized screening programs, targeted health education initiatives, and improved healthcare accessibility to reduce cervical cancer burden in the population.
References
• Arbyn, M., Weiderpass, E., Bruni, L., de Sanjosé, S., Saraiya, M., Ferlay, J., & Bray, F. (2020). Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. The Lancet Global Health, 8(2), e191-e203. https://doi.org/10.1016/S2214-109X(19)30482-6
• Arunadevi, K., Pushpa, S., & Amudha, G. (2014). Knowledge and awareness of cervical cancer among women attending a tertiary care hospital in Puducherry. Indian Journal of Medical and Paediatric Oncology, 35(2), 118-122. https://doi.org/10.4103/0971-5851.142040
• Aswathy, S., Quereshi, M. A., Kurian, B., & Leelamoni, K. (2012). Cervical cancer screening: Current knowledge & practice among women in a rural population of Kerala, India. Indian Journal of Medical Research, 136(2), 205-210. https://doi.org/10.4103/0971-5916.101226
• Bal, M. S., Goyal, R., Suri, A. K., & Mohi, M. K. (2012). Detection of abnormal cervical cytology in Papanicolaou smears. Journal of Cytology, 29(1), 45-47. https://doi.org/10.4103/0970-9371.93219
• Bamanikar, S. A., Baravkar, D. S., Chandanwale, S. S., & Dapkekar, P. (2014). Study of cervical Pap smears in a tertiary hospital. Indian Journal of Medical Sciences, 68(2), 75-80. https://doi.org/10.4103/0019-5359.140866
• Bobdey, S., Sathwara, J., Jain, A., & Balasubramaniam, G. (2016). Burden of cervical cancer and role of screening in India. Indian Journal of Medical and Paediatric Oncology, 37(4), 278-285. https://doi.org/10.4103/0971-5851.195751
• Bosch, F. X., Lorincz, A., Muñoz, N., Meijer, C. J., & Shah, K. V. (2002). The causal relation between human papillomavirus and cervical cancer. Journal of Clinical Pathology, 55(4), 244-265. https://doi.org/10.1136/jcp.55.4.244
• Freitas, A. C., Curado, M. P., Martins, E., Eckhardt, J., de Souza, M. L., Silva, A. M., & Villa, L. L. (2013). Liquid-based cytology versus conventional Pap smear: sample adequacy and diagnostic concordance in cervical cancer screening. Revista Brasileira de Ginecologia e Obstetrícia, 35(9), 404-408. https://doi.org/10.1590/S0100-72032013000900004
• Gupta, K., Malik, N. P., Sharma, V. K., Verma, N., & Gupta, A. (2012). Prevalence of cervical dysplasia in western Uttar Pradesh. Journal of Cytology, 29(4), 257-260. https://doi.org/10.4103/0970-9371.103949
• Joshi, C., Khurana, A., Chandra, S., Singh, M., & Gupta, N. (2014). Correlating Pap smear, colposcopy and histopathology in evaluation of cervix - a prospective study. Journal of Evolution of Medical and Dental Sciences, 3(13), 3366-3372. https://doi.org/10.14260/jemds/2014/2294
• Krishnan, S., Madsen, E., Porterfield, D., & Varghese, B. (2013). Advancing cervical cancer prevention in India: Implementation science priorities. The Oncologist, 18(12), 1285-1297. https://doi.org/10.1634/theoncologist.2013-0292
• Mulay, K., Swain, M., Patra, S., & Gowrishankar, S. (2009). A comparative study of cervical smears in an urban hospital in India and a population-based screening program in Mauritius. Indian Journal of Pathology and Microbiology, 52(1), 34-37. https://doi.org/10.4103/0377-4929.44964
• Muñoz, N., Franceschi, S., Bosetti, C., Moreno, V., Herrero, R., Smith, J. S., ... & Bosch, F. X. (2002). Role of parity and human papillomavirus in cervical cancer: the IARC multicentric case-control study. The Lancet, 359(9312), 1093-1101. https://doi.org/10.1016/S0140-6736(02)08151-5
• Nayak, A. M., Pfister, H., & Yenugu, V. (2012). Human papillomavirus antibodies and risk of cervical cancer: Pooled analysis of case-control studies. International Journal of Cancer, 131(11), 2702-2710. https://doi.org/10.1002/ijc.27514
• Nayar, R., & Wilbur, D. C. (2015). The Bethesda system for reporting cervical cytology: definitions, criteria, and explanatory notes. Springer. https://doi.org/10.1007/978-3-319-11074-5
• Nene, B., Jayant, K., Arrossi, S., Shastri, S., Budukh, A., Hingmire, S., ... & Sankaranarayanan, R. (2007). Determinants of women's participation in cervical cancer screening trial, Maharashtra, India. Bulletin of the World Health Organization, 85(4), 264-272. https://doi.org/10.2471/BLT.06.031195
• Patel, M. M., Pandya, A. N., & Modi, J. (2011). Cervical Pap smear study and its utility in cancer screening, to specify the strategy for cervical cancer control. National Journal of Community Medicine, 2(1), 49-51. https://doi.org/10.5455/njcm.2011.2.1.49-51
• Peto, J., Gilham, C., Fletcher, O., & Matthews, F. E. (2004). The cervical cancer epidemic that screening has prevented in the UK. The Lancet, 364(9430), 249-256. https://doi.org/10.1016/S0140-6736(04)16674-9
• Plummer, M., Herrero, R., Franceschi, S., Meijer, C. J., Snijders, P., Bosch, F. X., ... & Muñoz, N. (2003). Smoking and cervical cancer: pooled analysis of the IARC multi-centric case–control study. Cancer Causes & Control, 14(9), 805-814. https://doi.org/10.1023/B:CACO.0000003811.98261.3e
• Ranabhat, S. K., Shrestha, R., & Tiwari, M. (2014). Analysis of abnormal epithelial lesions in cervical Pap smears in mid-Western Nepal. Journal of Pathology of Nepal, 4(7), 557-560. https://doi.org/10.3126/jpn.v4i7.10295
• Sankaranarayanan, R., Budukh, A. M., & Rajkumar, R. (2001). Effective screening programmes for cervical cancer in low-and middle-income developing countries. Bulletin of the World Health Organization, 79(10), 954-962. https://doi.org/10.1590/S0042-96862001001000009
• Setia, M. S. (2016). Methodology series module 3: Cross-sectional studies. Indian Journal of Dermatology, 61(3), 261-264. https://doi.org/10.4103/0019-5154.182410
• Sharma, A., Kulkarni, V., Bhaskaran, U., Singha, M., Mujtahedi, S., Chatrath, A., ... & Kumar, N. (2012). Profile of abnormal cervical cytology in women attending outpatient department. Journal of Natural Science, Biology, and Medicine, 3(2), 138-141. https://doi.org/10.4103/0976-9668.101895
• Solomon, D., Davey, D., Kurman, R., Moriarty, A., O'Connor, D., Prey, M., ... & Young, N. (2002). The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA, 287(16), 2114-2119. https://doi.org/10.1001/jama.287.16.2114
• Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 71(3), 209-249. https://doi.org/10.3322/caac.21660
• World Health Organization. (2013). WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention. World Health Organization. https://doi.org/10.1136/bmjopen-2021-053528
• Yeoh, G. P., Chan, K. W., Lauder, I., Lam, M. Y., Fung, T. S., Tang, T. Y., & Or, Y. Y. (1999). Evaluation of thin-layer cytology and conventional Pap smears: A comparative study. Acta Cytologica, 43(2), 269-273. https://doi.org/10.1159/000331003
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Dr. Kasturi Barke
Associate Professor, Department of Obstetrics & Gynecology, JIET Medical College & Hospital, Jodhpur, Rajasthan
Dr. Amanjyot Kaur
Senior Resident, Department of Obstetrics & Gynecology, JIET Medical College & Hospital, Jodhpur, Rajasthan