Papanicolaou Smear in Abuja Revisited

Abstract

Background: Papinicolaou smear has been established as a cost effective screening method for Carcinoma of the cervix and had been used with celebrated successes in developed societies. Its utilization has remained abysmally low in Africa with attendant alarming rate of overt advanced cancer among her female population. Recent government public outreach programs abound and there is need to evaluate the effectiveness of these campaigns on the outcome of smear results with a view of future adjustment in outreach strategy.
Objectives: To review the results of Pap smears conducted in University of Abuja Teaching Hospital with a view of documenting the prevalence of positive smears among the study population.
Materials and Method: A three year retrospective study of Pap smears that were carried out at the University of Abuja Teaching Hospital between January 1, 2010 and December 31, 2012. The records of the patients were retrieved from medical record Department and analysed for age of the patient, parity, educational status, marital status, findings on vaginal examination, indication for pap smear and Pap smear results. The results were presented and discussed using simple percentages.
Results: One thousand two hundred and seventy four (1274) women had cervical smears during the study period. Ninety eight percent of patients were having their cervical screening for the first time at the mean age of 39.13±9.7 years. Positive Pap smear result was obtained in 39.5% of symptomatic and 24.4% of asymptomatic patients while Negative smears were recorded in 63.8% of the patients. Human Papilloma Virus (HPV) changes occurred in 5.7%, while atypical cells of undetermined significance (ASCUS) were observed in 4.9% of the patients. Low grade squamous intraepithelial lesions (LSIL) were the commonest cervical smear abnormality observed in 9.6% of the patients.
Conclusion: The mean age at first screening remain high with corresponding high rate of abnormal smear in both symptomatic and asymptomatic patients. The provider initiated counseling and testing is encouraged for early identification and treatment of precancerous lesions of Carcinoma of Cervix. Development and strict adherence of a National guideline for free routine screening of all women of reproductive life may increase the uptake.

Key words: Cervical cancer, Screening, Pap smear, Utilization.