Cytology screening for cervical cancer by conventional Pap smear: Experience at private hospital and diagnostic centre catering to sub urban population

Abstract

Background: Study of cervical cytology smears is the most popular effective screening tool for picking up precancerous lesions in asymptomatic women. Wide variability exists in the incidence of different cervical lesions contributed by complex geographic, socioeconomic, religious and cultural factors. The current study aimed to explore the spectrum of cervical cytology lesions and its presentation. Material and methods: The study was done at our private hospital and diagnostic centre catering to suburban and rural population. Institutional ethical committee clearance was obtained. Cases with colposcopicaly visible masses and those with inadequate clinical details were excluded from the study. A structured questionnaire was administered to consenting patients, to access awareness about cervical cancer and to obtain crucial data pertaining to their clinical history. 600 cases of cervical and vaginal vault smears collected over a period of 10 months from January 2019 to October 2019 were rescreened and reported as per The Bethesda System for reporting cervical cytology. The spectrum of cytological diagnosis observed was compared with that of similar studies. Also the most common clinical presentation was analysed. Results: We received samples from a wide age group of married women ranging from 16 to 83 years. Most of the participants (82.6%) undertook the test as part of Routine screening, under evaluation for other gynaecological issues. 17% of participants underwent the test as part of general health check-up. Only 3.67% of participants were aware of Pap smear being a screening test for cervical cancer. Menstrual cycle abnormalities was the most common gynaecological complaint among the participants, followed by cervical discharge. Of the 600 women screened, 27.86% were reported to have NILM with reactive changes, 14.87% showed evidence of a cervical microbial infection with bacterial vaginitis, trichomoniasis or candidiasis while 15.56% had epithelial cell/glandular abnormalities. Among the latter, premalignant lesions constituted 3.43% and malignant lesions constituted 0.34%. Infections were more common in younger age group. Conclusion: Multiple nationwide coordinated population studies are hence beneficial to understand local trends in the spectrum of cervical lesions and their clinical presentation. This becomes ever relevant in a largely conservative society with limited reproductive health awareness and resource poor setting where conventional cytology smears continue to save thousands of lives.